Provider Demographics
NPI:1669471116
Name:ROUF, MOHAMED-IQBAL PASHA (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED-IQBAL
Middle Name:PASHA
Last Name:ROUF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2799 W GRAND BLVD, CFP 417
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-916-8144
Mailing Address - Fax:313-916-4460
Practice Address - Street 1:2799 W GRAND BLVD # 417
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-8144
Practice Address - Fax:313-916-4460
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079037208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI48473410Medicaid
MI4775017/10Medicaid
I41546Medicare UPIN
MI4775017/10Medicaid