Provider Demographics
NPI:1467705798
Name:MOHAMED, TAREK LOTFY IBRAHIM (MD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:LOTFY IBRAHIM
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD # A109F
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:SPARROW HOSPITAL, NEONATOLOGY UNIT, 3RD FLOOR
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-364-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010998722080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1467535211Medicaid