Healthcare Provider Details

I. General information

NPI: 1790031698
Provider Name (Legal Business Name): RINI SAHEWALLA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2012
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST PEDIATRICS EDUCATION OFFICE, THIRD FLOOR
DETROIT MI
48201-2119
US

IV. Provider business mailing address

751 LINCOLN LN 1403
DEARBORN MI
48126-6100
US

V. Phone/Fax

Practice location:
  • Phone: 313-743-5427
  • Fax:
Mailing address:
  • Phone: 313-510-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberR7312
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301101367
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: