Provider Demographics
NPI:1053438614
Name:DAKDOUK, MOHAMAD H (DR)
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:H
Last Name:DAKDOUK
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12866 FORT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1060
Mailing Address - Country:US
Mailing Address - Phone:734-288-3588
Mailing Address - Fax:734-288-3610
Practice Address - Street 1:12866 FORT ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1060
Practice Address - Country:US
Practice Address - Phone:734-288-3588
Practice Address - Fax:734-288-3610
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist