Provider Demographics
NPI:1063484053
Name:HAQUE, MOHAMMED ZIAAL (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:ZIAAL
Last Name:HAQUE
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 1:14071 E 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2335
Mailing Address - Country:US
Mailing Address - Phone:313-371-2828
Mailing Address - Fax:
Practice Address - Street 1:14071 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2335
Practice Address - Country:US
Practice Address - Phone:313-371-2828
Practice Address - Fax:313-371-9120
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061429207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4600342-10Medicaid
G58625Medicare UPIN
MI4600342-10Medicaid