Provider Demographics
NPI:1346348760
Name:MOHAMMAD GHAFFARLOO M.D.P.C.
Entity Type:Organization
Organization Name:MOHAMMAD GHAFFARLOO M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAFFARLOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-286-8677
Mailing Address - Street 1:15945 19 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1147
Mailing Address - Country:US
Mailing Address - Phone:586-286-8677
Mailing Address - Fax:586-286-8781
Practice Address - Street 1:15945 19 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1147
Practice Address - Country:US
Practice Address - Phone:586-286-8677
Practice Address - Fax:586-286-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056996207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI43391 COMMONS CLINTOOtherPREVIOUS ADDRESS