# MOHAMMAD DERANI MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dearborn Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063725620
- **Authorized official:** MOHAMMAD DERANI M.D. (OWNER)
- **Authorized official phone:** (313) 581-0909

## Contact information

- **Practice address:** 15401 W WARREN AVE, DEARBORN, MI 48126-1359
- **Practice address phone:** (313) 581-0909
- **Practice address fax:** (313) 581-3252
- **Mailing address:** 15401 W WARREN AVE, DEARBORN, MI 48126-1359
- **Mailing address phone:** (313) 581-0909
- **Mailing address fax:** (313) 581-3252

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 4301045768 | MI | Yes |

## Other

- **Enumeration date:** 07/23/2010
- **Last updated:** 02/18/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 190127-10 | — | MI |