Provider Demographics
NPI:1972584191
Name:BARAWI, MOHAMMED (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:BARAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28963 LITTLE MACK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3017
Mailing Address - Country:US
Mailing Address - Phone:586-447-0700
Mailing Address - Fax:586-447-0795
Practice Address - Street 1:28963 LITTLE MACK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3015
Practice Address - Country:US
Practice Address - Phone:586-447-0700
Practice Address - Fax:586-498-0707
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075513207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
6132498003OtherCIGNA
MI4227658-10Medicaid
P109705OtherBCN
5916125OtherAETNA
MIOM49130Medicare PIN
MI4227658-10Medicaid