Mujtaba Moazzam, M.D.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

4351051684 Issued in MI

Practice address

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

Phone

(248) 551-3850

NPI assigned

Jun 26, 2023

Reactivated

May 2, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782518400000",
    "number": "1285310193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-551-3850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-551-3850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOAZZAM",
        "first_name": "MUJTABA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-26",
        "last_updated": "2026-06-27",
        "certification_date": "2026-06-27",
        "deactivation_date": "2024-02-02",
        "reactivation_date": "2024-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "4351051684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Mitchell
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• Carol Mitri, MD
• Jennifer B Mitsuya, D.O.
• Emlily Kathryn Mlynarek, PA
• Mobile Medical Consultant PLLC
• Mobile Physical Therapy LLC
• Hiba Mobin, M.D.
• Sunjay Modi
• Reema Mody, DO

• Geriatric Medicine (Internal Medicine) Physician in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Geriatric Medicine (Internal Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.