Provider Demographics
NPI:1982997094
Name:MUIZUDDIN, MUHAMMAD K (PA)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:K
Last Name:MUIZUDDIN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:CREDENTIALING/PAYER CONTRACTING SERVICES
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:734-632-0182
Practice Address - Street 1:33155 ANNAPOLIS ST
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2405
Practice Address - Country:US
Practice Address - Phone:734-467-4042
Practice Address - Fax:734-467-5500
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-06-29
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Provider Licenses
StateLicense IDTaxonomies
MI5601005992363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGOtherBCBSMI
PENDINGOtherCAQH