Basic Information
| Provider Information | |||||||||
| NPI: | 1750380408 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARSIWALA | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 17197 N LAUREL PARK DR | ||||||||
| Address2: | STE 107 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481527910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345426100 | ||||||||
| FaxNumber: | 7345426102 | ||||||||
| Practice Location | |||||||||
| Address1: | 37595 7 MILE RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481521003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345426100 | ||||||||
| FaxNumber: | 7345426102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 05/18/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301065784 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110H227310 | 01 | MI | BCBS | OTHER | 700H221550 | 01 | MI | BCBS | OTHER | 700H229760 | 01 | MI | BCBS | OTHER | P00685041 | 01 | MI | RAILROAD MEDICARE | OTHER | P00826913 | 01 | MI | RAILROAD MEDICARE | OTHER | 4603184 | 05 | MI | MEDICAID | 4995709 | 05 | MI | MEDICAID | 700H228480 | 01 | MI | BCN | OTHER | 4113719 | 05 | MI | MEDICAID | DN2395 | 01 | MI | RAILROAD MEDICARE GROUP | OTHER | P00951226 | 01 | MI | RAILROAD MEDICARE IND PIN | OTHER | 1750380408 | 05 | MI | MEDICAID | 1861791998 | 05 | MI | MEDICAID | 740H107360 | 01 | MI | BCBS OF MI | OTHER | 2838139 | 01 | MI | MEDICAID OHIO | OTHER | 4843707 | 05 | MI | MEDICAID | P00610343 | 01 | MI | RAILROAD MEDICARE | OTHER | 0227034 | 01 | MI | DEPT OF LABOR MI | OTHER | 1108268351 | 01 | MI | BCBS | OTHER | 110E017250 | 01 | MI | BCBS | OTHER | 700E019030 | 01 | MI | BCN | OTHER | 700H222890 | 01 | MI | BCN | OTHER | 1477806875 | 05 | MI | MEDICAID | 20833330800 | 01 | MI | OHIO WORK COMP | OTHER | 4722882 | 05 | MI | MEDICAID |