Provider Demographics
NPI:1396728507
Name:MOMIN, FEROZE A (MD)
Entity type:Individual
Prefix:DR
First Name:FEROZE
Middle Name:A
Last Name:MOMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13530 MICHIGAN AVE
Mailing Address - Street 2:STE 242
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3575
Mailing Address - Country:US
Mailing Address - Phone:313-388-6299
Mailing Address - Fax:313-388-6328
Practice Address - Street 1:2021 MONROE ST STE 203
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2926
Practice Address - Country:US
Practice Address - Phone:313-388-6299
Practice Address - Fax:313-388-6328
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2025-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051771207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01004356OtherHEALTH PLUS
MIF25010OtherHAP
MI1396728507Medicaid
MI431518910Medicaid
MI48121OtherOMNICARE
MI900003803OtherRAILROAD MEDICARE
MI014995OtherMIDWEST HEALTH PLAN
MI1105020291OtherBCBS
MICH9161OtherRAILROAD MEDICARE GROUP
MI110E002110OtherBCBS
MI124278OtherGREAT LAKES
MI481780510Medicaid
MI431518910Medicaid
MI1396728507Medicaid