Provider Demographics
NPI:1164642302
Name:MAHMOOD, SULTAN (RPT)
Entity Type:Individual
Prefix:MR
First Name:SULTAN
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56187 NICKELBY SOUTH
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316
Mailing Address - Country:US
Mailing Address - Phone:248-542-7440
Mailing Address - Fax:248-545-4327
Practice Address - Street 1:27031 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HTS
Practice Address - State:MI
Practice Address - Zip Code:48071
Practice Address - Country:US
Practice Address - Phone:248-542-7440
Practice Address - Fax:248-545-4327
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35778OtherBCBSM PHYSICAL THERAPY
MI0F35778OtherBCBSM PHYSICAL THERAPY