Provider Demographics
NPI:1568440774
Name:MEMON, MUBEEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MUBEEN
Middle Name:A
Last Name:MEMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2092 S CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-9583
Mailing Address - Country:US
Mailing Address - Phone:734-457-2161
Mailing Address - Fax:734-457-4146
Practice Address - Street 1:2092 S CUSTER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9583
Practice Address - Country:US
Practice Address - Phone:734-457-2161
Practice Address - Fax:734-457-4146
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010735302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4744173Medicaid
MI4744191Medicaid
MIH02379Medicare UPIN
MI4744173Medicaid