Provider Demographics
NPI:1174193692
Name:ZAWAHRA, MOHANAD
Entity Type:Individual
Prefix:
First Name:MOHANAD
Middle Name:
Last Name:ZAWAHRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 STEADMAN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3089
Mailing Address - Country:US
Mailing Address - Phone:313-415-4616
Mailing Address - Fax:
Practice Address - Street 1:15001 MICHIGAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-6600
Practice Address - Country:US
Practice Address - Phone:313-757-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician