Healthcare Provider Details

I. General information

NPI: 1821369794
Provider Name (Legal Business Name): MOHAMMAD IMRAN SHEIKH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR
DETROIT MI
48235-2624
US

IV. Provider business mailing address

20445 ANN ARBOR TRL
DEARBORN HTS MI
48127-2632
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-3250
  • Fax:
Mailing address:
  • Phone: 313-271-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301099709
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number4301099709
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: