Provider Demographics
NPI:1275585200
Name:MAHMOOD, FAZLEOMAR (MD)
Entity Type:Individual
Prefix:
First Name:FAZLEOMAR
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:14650 E OLD US HIGHWAY 12
Practice Address - Street 2:SUITE 301
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1801
Practice Address - Country:US
Practice Address - Phone:734-593-5990
Practice Address - Fax:734-593-5995
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIFM080247207R00000X
MI4301080247207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine