Provider Demographics
NPI:1437392552
Name:MOHAMMED S HAQ MD P C
Entity Type:Organization
Organization Name:MOHAMMED S HAQ MD P C
Other - Org Name:VAN DYKE MEDICAL CENTER P C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:SIRAJUL
Authorized Official - Last Name:HAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-819-8155
Mailing Address - Street 1:624 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1842
Mailing Address - Country:US
Mailing Address - Phone:248-541-2800
Mailing Address - Fax:248-548-5385
Practice Address - Street 1:624 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1842
Practice Address - Country:US
Practice Address - Phone:248-541-2800
Practice Address - Fax:248-548-5385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMH045683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MH045683OtherLICENSE NUMBER
MI4483371-10Medicaid
MH045683OtherLICENSE NUMBER
MI4483371-10Medicaid