Provider Demographics
NPI:1578715603
Name:SADIQ, MOHAMMED (PT)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMED
Middle Name:
Last Name:SADIQ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 PINE WAY DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2094
Mailing Address - Country:US
Mailing Address - Phone:248-879-0091
Mailing Address - Fax:248-879-0895
Practice Address - Street 1:6812 PINE WAY DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2094
Practice Address - Country:US
Practice Address - Phone:248-879-0091
Practice Address - Fax:248-879-0895
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003720171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor