Provider Demographics
NPI:1861753725
Name:REZA KAHNAMOUEI MD PLLC
Entity type:Organization
Organization Name:REZA KAHNAMOUEI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMADREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHNAMOUEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-622-0582
Mailing Address - Street 1:1401 KIRKWAY RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1318
Mailing Address - Country:US
Mailing Address - Phone:313-622-0582
Mailing Address - Fax:
Practice Address - Street 1:43301 COMMONS DR
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1109
Practice Address - Country:US
Practice Address - Phone:586-745-3006
Practice Address - Fax:586-935-3762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2014-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090040207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty