Provider Demographics
NPI:1780639450
Name:MAHFOOZ, NAVEED (MD)
Entity Type:Individual
Prefix:
First Name:NAVEED
Middle Name:
Last Name:MAHFOOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 W CARO RD
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9686
Mailing Address - Country:US
Mailing Address - Phone:989-672-2100
Mailing Address - Fax:
Practice Address - Street 1:1525 W CARO RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9260
Practice Address - Country:US
Practice Address - Phone:989-672-2100
Practice Address - Fax:989-672-0748
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059644207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689022469Medicaid
MI4800281Medicaid
MI1659326395Medicaid
MIPENDINGMedicare Oscar/Certification
MIF93077Medicare UPIN
MI4800281Medicaid
MI1659326395Medicaid
MIP26070001Medicare PIN