Provider Demographics
NPI:1689897175
Name:MOHAMMAD NAVAI
Entity Type:Organization
Organization Name:MOHAMMAD NAVAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-624-6633
Mailing Address - Street 1:1935 N PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3157
Mailing Address - Country:US
Mailing Address - Phone:248-624-6633
Mailing Address - Fax:
Practice Address - Street 1:1935 N PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3157
Practice Address - Country:US
Practice Address - Phone:248-624-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMN039162208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1619331Medicaid
MI1619331Medicaid