Provider Demographics
NPI:1821201468
Name:MOHAMED SOOFI, MD PC
Entity Type:Organization
Organization Name:MOHAMED SOOFI, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:AMJAD
Authorized Official - Last Name:SOOFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-241-2726
Mailing Address - Street 1:2252 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4254
Mailing Address - Country:US
Mailing Address - Phone:734-241-2726
Mailing Address - Fax:734-241-2744
Practice Address - Street 1:2252 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4254
Practice Address - Country:US
Practice Address - Phone:734-241-2726
Practice Address - Fax:734-241-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS049788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB47598OtherHAP
MI4036635OtherAETNA
MI4075860Medicaid
MI080E811500OtherBLUE CROSS BLUE SHIELD
MI4075860Medicaid
MI4075860Medicaid
MIB47598OtherHAP