Provider Demographics
NPI:1336161280
Name:AGHA INTERNAL MEDICINE ASSOCIATES PC
Entity Type:Organization
Organization Name:AGHA INTERNAL MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-855-4176
Mailing Address - Street 1:15604 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2852
Mailing Address - Country:US
Mailing Address - Phone:734-855-4176
Mailing Address - Fax:734-855-4178
Practice Address - Street 1:15604 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2852
Practice Address - Country:US
Practice Address - Phone:734-855-4176
Practice Address - Fax:734-855-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHA079451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4415881Medicaid
OP00940Medicare ID - Type Unspecified
MI4415881Medicaid