Basic Information
| Provider Information | |||||||||
| NPI: | 1316068653 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOUMAA | ||||||||
| FirstName: | MOUHAMMED | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50505 SCHOENHERR RD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483153140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865803062 | ||||||||
| FaxNumber: | 5865803143 | ||||||||
| Practice Location | |||||||||
| Address1: | 25910 KELLY RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | ROSEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480664466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867723366 | ||||||||
| FaxNumber: | 5867723355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 03/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 4301074133 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 5315023267 | 01 | MI | CONTROLLED SUBSTANCE LICE | OTHER | 4301074133 | 01 | MI | PHYSICIAN LICENSE | OTHER |