Healthcare Provider Details

I. General information

NPI: 1659370815
Provider Name (Legal Business Name): SHEILA PRASAD MEFTAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33200 W 14 MILE RD SUITE 200
WEST BLOOMFIELD MI
48322-3549
US

IV. Provider business mailing address

30349 KINGSWAY DR
FARMINGTON HILLS MI
48331-1680
US

V. Phone/Fax

Practice location:
  • Phone: 248-737-2402
  • Fax: 248-737-2501
Mailing address:
  • Phone: 248-737-2402
  • Fax: 248-737-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberSM407554
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: