Provider Demographics
NPI:1043260342
Name:NOUNOU, MAJED (MD)
Entity Type:Individual
Prefix:DR
First Name:MAJED
Middle Name:
Last Name:NOUNOU
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 1:1075 SUNCREST DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-4403
Mailing Address - Country:US
Mailing Address - Phone:810-667-7333
Mailing Address - Fax:810-660-8133
Practice Address - Street 1:1075 SUNCREST DR
Practice Address - Street 2:SUITE C
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4403
Practice Address - Country:US
Practice Address - Phone:810-667-7333
Practice Address - Fax:810-660-8133
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091738207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6406001OtherMEDICARE PTAN
MI4301091738OtherMI STATE LICENSE
0-558-587-2OtherECFMG
0-558-587-2OtherECFMG