Healthcare Provider Details

I. General information

NPI: 1326227877
Provider Name (Legal Business Name): HELEN ETEMADI DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 KING RD STE. C
RIVERVIEW MI
48193-7909
US

IV. Provider business mailing address

14700 KING RD STE. C
RIVERVIEW MI
48193-7909
US

V. Phone/Fax

Practice location:
  • Phone: 734-479-2100
  • Fax:
Mailing address:
  • Phone: 734-479-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101012713
License Number StateMI

VIII. Authorized Official

Name: DR. HELEN ETEMADI
Title or Position: OWNER
Credential: DO
Phone: 734-479-2100