Provider Demographics
NPI:1669153128
Name:TANANA, MAHMOUD
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:TANANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6153
Mailing Address - Country:US
Mailing Address - Phone:586-553-9116
Mailing Address - Fax:
Practice Address - Street 1:3555 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6153
Practice Address - Country:US
Practice Address - Phone:586-553-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health