Active NPI
Wiaam Mahboub
- Internal Medicine Physician
- Dearborn, MI
National Provider Identifier
1497240352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4301505332
- Practice address
- 2040 Monroe St
Dearborn, MI 48124-2950 - Phone
- (313) 278-5836
- NPI assigned
- Jun 24, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301505332 | MI | Primary |
Addresses
Primary practice location
2040 Monroe St
Dearborn, MI 48124-2950
Mailing address
2040 Monroe St
Dearborn, MI 48124-2950
Phone (313) 278-5836
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717459200000",
"number": "1497240352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2040 MONROE ST",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481242950",
"telephone_number": "313-278-5836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2040 MONROE ST",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481242950",
"telephone_number": "313-278-5836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHBOUB",
"first_name": "WIAAM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-24",
"last_updated": "2024-06-04",
"certification_date": "2024-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301505332",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; 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.