Provider Demographics
NPI:1679725154
Name:FASIUDDIN, NAJAM MOHAMMAD (DO)
Entity Type:Individual
Prefix:DR
First Name:NAJAM
Middle Name:MOHAMMAD
Last Name:FASIUDDIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LINCOLN LN
Mailing Address - Street 2:APT 2801
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-6106
Mailing Address - Country:US
Mailing Address - Phone:732-213-4779
Mailing Address - Fax:
Practice Address - Street 1:5450 FORT ST
Practice Address - Street 2:MEDICAL EDUCATION
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4601
Practice Address - Country:US
Practice Address - Phone:734-671-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017662207P00000X
MI5315035986207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine