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Individual

MAHAM MUSHTAQ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
16258 FORT ST, SOUTHGATE, MI 48195-1401
(734) 250-9062
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601008981
MI
363AM0700X
Medical Physician Assistant
10001768A
IN

Other

Enumeration date
11/07/2014
Last updated
10/04/2022
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