Healthcare Provider Details

I. General information

NPI: 1801129218
Provider Name (Legal Business Name): NICHOLAS SABAH YELDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD # 435
DETROIT MI
48202-2608
US

IV. Provider business mailing address

2799 W GRAND BLVD # E435
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-8445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number4301104052
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: