Provider Demographics
NPI:1336636398
Name:ALSHAMI, MOTAZ SAMIH MUSTAFA (MD)
Entity Type:Individual
Prefix:MR
First Name:MOTAZ
Middle Name:SAMIH MUSTAFA
Last Name:ALSHAMI
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 1:3901 CHRYSLER SERVICE DRIVE, WSU TOLAN PARK MEDICAL BUI
Mailing Address - Street 2:SUITE 5-A
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-577-7523
Mailing Address - Fax:
Practice Address - Street 1:3901 CHRYSLER SERVICE DRIVE, WSU TOLAN PARK MEDICAL BUI
Practice Address - Street 2:SUITE 5-A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-577-7523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.1599792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program