NPIMap

Individual provider Active NPI

Mustapha Mohamed Mallah, M.D.

  • Rheumatology Physician
  • Wyandotte, MI
National Provider Identifier
1104879683
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
MI-4301081080 Issued in MI
Practice address
1623 Ford Ave
Wyandotte, MI 48192-2303
Phone
(734) 389-7167
Fax
(734) 282-7390
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X MI-4301081080 MI Primary

Addresses

Primary practice location

1623 Ford Ave
Wyandotte, MI 48192-2303

Mailing address

29992 Northwestern Hwy Ste C
Farmington Hills, MI 48334-3292

Other identifiers 1

IdentifierTypeStateIssuer
104331557MedicaidMI

Other names 1

  • Dr. Moustafa Mohamed Mallah Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040211000323 MI Practitioner - RheumatologyPractitioner - Internal MedicinePractitioner - Psychiatry 1850285875 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
RheumatologyAlso: Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Michigan Healthcare Professionals PCGroup PAC ID 0345413258, 525 clinicians
Dearborn Physical Therapy LTDGroup PAC ID 2668383910, 97 clinicians

Practice addresses (Care Compare)

1213 Mason St
Dearborn, MI 48124-2841
Phone (313) 278-2800

23852 Michigan Ave
Dearborn, MI 48124-1829

27900 Grand River Ave
Suite 220
Farmington Hills, MI 48336-5965
Phone (248) 477-0552

Hospital & facility affiliations

  • Beaumont Hospital - Dearborn Hospital, Dearborn, MI, CCN 230020
  • Wyandotte Hospital and Medical Center Hospital, Wyandotte, MI, CCN 230146
  • Beaumont Hospital - Taylor Hospital, Taylor, MI, CCN 230270
  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MI-4301081080MIMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Healthcare Professionals PC CurrentSince Jul 1, 2023 Accepting new patients
Michigan Healthcare Professionals PC CurrentSince Jul 1, 2023 Accepting new patients
Michigan Healthcare Professionals PC Rheumatology Current Accepting new patients
Wassim Younes MD PLC CurrentSince Aug 1, 2018 Accepting new patients
Imperial Home Healthcare,LLC Past Accepting new patients
A Access PC PastSince Apr 10, 2018 Accepting new patients
Oakwood Group IX, LLC Past Accepting new patients

Locations

1611 Monroe St
Dearborn, MI 48124
Phone (313) 254-4039

18101 Oakwood Blvd
Dearborn, MI 48124
Phone (313) 593-8780

1213 Mason St
Dearborn, MI 48124
Phone (313) 278-2800

1213 Mason St
Ste 3
Dearborn, MI 48124

27900 Grand River Ave
Ste 220
Farmington Hills, MI 48336
Phone (248) 477-0552

29992 Northwestern Hwy
Ste C
Farmington Hills, MI 48334
Phone (248) 851-1430

1221 Pine Grove Ave
Port Huron, MI 48060
Phone (810) 989-3300

1623 Ford Ave
Wyandotte, MI 48192
Phone (734) 282-7000

Interoperability endpoints

  • Direct secure messaging: mmallah60092@direct.hfhs.org
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 19

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 19

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1104879683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29992 NORTHWESTERN HWY STE C",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1623 FORD AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481922303",
            "telephone_number": "734-389-7167",
            "fax_number": "734-282-7390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLAH",
        "first_name": "MUSTAPHA",
        "middle_name": "MOHAMED",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MI",
            "license": "MI-4301081080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104331557",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOUSTAFA",
            "last_name": "MALLAH",
            "middle_name": "MOHAMED",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wyandotte, MI

Sources for this page

Verify at the official NPI Registry.