Provider Demographics
NPI:1669409439
Name:MASRI, MOHAMMED T (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:T
Last Name:MASRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 HARRINGTON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2903
Mailing Address - Country:US
Mailing Address - Phone:586-493-3440
Mailing Address - Fax:586-493-3445
Practice Address - Street 1:1080 HARRINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2903
Practice Address - Country:US
Practice Address - Phone:586-493-3440
Practice Address - Fax:586-493-3445
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106637207RH0003X
IA29341207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1909663Medicaid
IAF60869Medicare UPIN
IA42732Medicare PIN