Provider Demographics
NPI:1407528672
Name:JOZ, MOHAMMED KHORRAM (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:KHORRAM
Last Name:JOZ
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:455 E EISENHOWER PKWY STE 300-1016
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3356
Mailing Address - Country:US
Mailing Address - Phone:248-983-1070
Mailing Address - Fax:248-780-3805
Practice Address - Street 1:455 E EISENHOWER PKWY STE 300-1016
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3356
Practice Address - Country:US
Practice Address - Phone:248-983-1070
Practice Address - Fax:248-780-3805
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704252327363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health