1023169992 NPI number — SHEILA P MEFTAH, MD, PLLC

Table of content: (NPI 1023169992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023169992 NPI number — SHEILA P MEFTAH, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHEILA P MEFTAH, MD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023169992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30349 KINGSWAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48331-1680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-737-2402
Provider Business Mailing Address Fax Number:
248-737-2501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33200 W 14 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48322-3549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-737-2402
Provider Business Practice Location Address Fax Number:
248-737-2501
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEFTAH
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-737-2402

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301407554 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1106335411 . This is a "BCBSMI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4148723 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 377774 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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