Provider Demographics
NPI:1780693184
Name:MOOTY, MOHAMAD Y (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:Y
Last Name:MOOTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:363 FREMONT ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3389
Mailing Address - Country:US
Mailing Address - Phone:269-245-8302
Mailing Address - Fax:269-245-8309
Practice Address - Street 1:363 FREMONT ST
Practice Address - Street 2:SUITE 305
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3389
Practice Address - Country:US
Practice Address - Phone:269-245-8302
Practice Address - Fax:269-245-8309
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME016684207RI0200X
MI4301110671207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEI44335Medicare UPIN