Healthcare Provider Details

I. General information

NPI: 1659986164
Provider Name (Legal Business Name): DR. WASFEH MUSHEINESH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5831 W VERNOR HWY
DETROIT MI
48209-2159
US

IV. Provider business mailing address

5831 W VERNOR HWY
DETROIT MI
48209-2159
US

V. Phone/Fax

Practice location:
  • Phone: 313-409-1441
  • Fax:
Mailing address:
  • Phone: 313-409-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WASFEH MUSHEINESH
Title or Position: PRESIDENT/HEALTH CARE PROVIDER
Credential: M.D.
Phone: 313-409-1441