Healthcare Provider Details

I. General information

NPI: 1427419662
Provider Name (Legal Business Name): SHOAIB A RASHEED D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MCDOUGALL ST
DETROIT MI
48207-4291
US

IV. Provider business mailing address

21700 NORTHWESTERN HWY
SOUTHFIELD MI
48075-4906
US

V. Phone/Fax

Practice location:
  • Phone: 855-445-4554
  • Fax:
Mailing address:
  • Phone: 855-445-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number5304732020
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: