Provider Demographics
NPI:1710568290
Name:MAKI, MOHAMED AHMED (MBBCH BAO)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AHMED
Last Name:MAKI
Suffix:
Gender:M
Credentials:MBBCH BAO
Other - Prefix:
Other - First Name:MOHAMED
Other - Middle Name:AHMED
Other - Last Name:AL-HADDAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBCH BAO
Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301511312207RC0000X
390200000X
MI4351048436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program