Healthcare Provider Details

I. General information

NPI: 1487192993
Provider Name (Legal Business Name): PULMONARY, INTERNAL AND EMERGENCY MEDICINE AND RADIOLOGY ASSO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26699 W 12 MILE RD SUITE 101
SOUTHFIELD MI
48034-1578
US

IV. Provider business mailing address

26699 W 12 MILE RD SUITE 101
SOUTHFIELD MI
48034-1578
US

V. Phone/Fax

Practice location:
  • Phone: 248-358-4783
  • Fax: 248-359-1491
Mailing address:
  • Phone: 248-358-4783
  • Fax: 248-359-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: SHYAM MAHESH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-358-4783