Provider Demographics
NPI:1972180131
Name:MOHAMED, MOHAMED A (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:A
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8348 LITTLE ROAD
Mailing Address - Street 2:STE 149
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-4919
Mailing Address - Country:US
Mailing Address - Phone:616-366-4234
Mailing Address - Fax:855-548-4481
Practice Address - Street 1:600 MONROE AVENUE NW
Practice Address - Street 2:STE 104
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1470
Practice Address - Country:US
Practice Address - Phone:616-366-4234
Practice Address - Fax:855-548-4481
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301510896208000000X, 2084N0400X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology