Provider Demographics
NPI:1942297270
Name:MOHAMED, IMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IMAN
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3731
Mailing Address - Country:US
Mailing Address - Phone:269-382-2500
Mailing Address - Fax:
Practice Address - Street 1:3120 GLENDALE AVE
Practice Address - Street 2:MEDICINE
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614
Practice Address - Country:US
Practice Address - Phone:419-383-3747
Practice Address - Fax:419-383-6372
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077273207RH0003X
MI4301058580207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2135737Medicaid
OH2135737Medicaid
OHMO0894502Medicare ID - Type Unspecified