Provider Demographics
NPI:1033398177
Name:A.M. MUSSANI, MD., P.C.
Entity Type:Organization
Organization Name:A.M. MUSSANI, MD., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDULQADIR
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUSSANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-284-2090
Mailing Address - Street 1:12815 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1109
Mailing Address - Country:US
Mailing Address - Phone:734-284-2090
Mailing Address - Fax:734-284-9666
Practice Address - Street 1:12815 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1109
Practice Address - Country:US
Practice Address - Phone:734-284-2090
Practice Address - Fax:734-284-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty