Provider Demographics
NPI:1598792830
Name:ALKOTOB, MOHAMMAD LUAY (MD, FACC, FSCAI)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:LUAY
Last Name:ALKOTOB
Suffix:
Gender:M
Credentials:MD, FACC, FSCAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6122 W PIERSON RD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-3104
Mailing Address - Country:US
Mailing Address - Phone:810-600-3399
Mailing Address - Fax:810-600-3398
Practice Address - Street 1:6122 W PIERSON RD
Practice Address - Street 2:UNIT 1
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-3104
Practice Address - Country:US
Practice Address - Phone:810-600-3399
Practice Address - Fax:810-600-3398
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088032207RC0000X
MI4301089854207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1703Medicare PIN
H55881Medicare UPIN