Individual
DR. SHOHREH MOAZAMI IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301062801
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00994
HEALTH PLAN OF MICHIGAN
MI
01
—
12-31350
UNITED HEALTH CARE
MI
01
—
147687
GREAT LAKES HEALTH PLAN
MI
01
—
3501310791
BLUE CROSS BLUE SHEILD
MI
01
—
5922108
AETNA
MI
Enumeration date
07/26/2005
Last updated
07/08/2007
Update your record
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