Healthcare Provider Details

I. General information

NPI: 1235305053
Provider Name (Legal Business Name): SOUDABEH AHADI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 COLE RD
MONROE MI
48162-4103
US

IV. Provider business mailing address

55 COLE ROAD
MONROE MI
48162
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-2022
  • Fax: 734-242-2251
Mailing address:
  • Phone: 734-242-2022
  • Fax: 734-242-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301036376
License Number StateMI

VIII. Authorized Official

Name: DR. SOUDABEH AHADI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 734-242-2022