Individual ProviderMujtaba MoazzamInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address3601 W. 13 Mile Road, Royal Oak, MI 48073(248) 551-3000PECOS EnrollmentBased on the most recent information from CMS, provider Mujtaba Moazzam is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 9:21 AM.Profile DetailsProvider ID1285310193Provider TypeIndividualFull NameMoazzam, MujtabaCredentialM.D.GenderMaleSole ProprietorNoEnumeration Date6/26/2023Last Updated5/2/2024Contact InformationPractice LocationPractice Address3601 W. 13 Mile Road, Royal Oak, MI 48073Phone(248) 551-3000Fax(248) 551-9425Mailing LocationMailing Address3601 W. 13 Mile Road, Royal Oak, MI 48073Phone(248) 551-3000Fax(248) 551-9425Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense4351051684Michigan