Provider Demographics
NPI:1457687584
Name:MOHAMAD, TAMAM
Entity Type:Individual
Prefix:DR
First Name:TAMAM
Middle Name:
Last Name:MOHAMAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22720 MICHIGAN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2021
Mailing Address - Country:US
Mailing Address - Phone:313-791-3000
Mailing Address - Fax:313-791-2800
Practice Address - Street 1:4160 JOHN R ST STE 510
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2021
Practice Address - Country:US
Practice Address - Phone:313-993-7777
Practice Address - Fax:313-993-2563
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-24
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083919207RC0000X, 282N00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No282N00000XHospitalsGeneral Acute Care Hospital