Provider Demographics
NPI:1801874516
Name:HAQ, MOHAMMED SIRAJUL (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:SIRAJUL
Last Name:HAQ
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 1:624 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1842
Mailing Address - Country:US
Mailing Address - Phone:248-541-2800
Mailing Address - Fax:248-548-5385
Practice Address - Street 1:624 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1842
Practice Address - Country:US
Practice Address - Phone:248-541-2800
Practice Address - Fax:248-548-5385
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMH045683207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101861OtherGREAT LAKES HEALTH PLAN
MID91370OtherHAP
MI100071OtherMOLINA HEALTH CARE
MI201041OtherULTIMED
MI1106317002OtherBCBS
MID91370Medicare UPIN
MI101861OtherGREAT LAKES HEALTH PLAN