Healthcare Provider Details

I. General information

NPI: 1871667071
Provider Name (Legal Business Name): WALID DEMASHKIEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 ELECTRIC AVE SUITE B
PORT HURON MI
48060-6589
US

IV. Provider business mailing address

PO BOX 610669
PORT HURON MI
48061-0669
US

V. Phone/Fax

Practice location:
  • Phone: 810-984-1148
  • Fax: 810-984-1149
Mailing address:
  • Phone: 810-985-1884
  • Fax: 810-966-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301039123
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: