Provider Demographics
NPI:1831985530
Name:ISLAM, MADHIHA
Entity type:Individual
Prefix:
First Name:MADHIHA
Middle Name:
Last Name:ISLAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29647 OHMER DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3374
Mailing Address - Country:US
Mailing Address - Phone:313-485-2325
Mailing Address - Fax:
Practice Address - Street 1:9632 CONANT ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3305
Practice Address - Country:US
Practice Address - Phone:313-871-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant