Provider Demographics
NPI:1043604135
Name:REZA, MOHSIN MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHSIN
Middle Name:MOHAMMAD
Last Name:REZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2717 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-9217
Mailing Address - Country:US
Mailing Address - Phone:734-241-2117
Mailing Address - Fax:734-241-7589
Practice Address - Street 1:2717 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-9217
Practice Address - Country:US
Practice Address - Phone:734-241-2117
Practice Address - Fax:734-241-7589
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138408207Q00000X
MI4301107643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine