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General NPI Number Information
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NPI Number | 1235305053
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Entity Type | Organization
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Legal Business Name | SOUDABEH AHADI MD PC
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 55 COLE RD
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City | MONROE
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State | MI
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Zip | 48162-4103
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Country | US
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Telephone | 734-242-2022
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Fax | 734-242-2251
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Provider Business Mailing Address
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Address Line | 55 COLE ROAD
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City | MONROE
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State | MI
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Zip | 48162
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Country | US
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Telephone | 734-242-2022
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Fax | 734-242-2251
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SOUDABEH AHADI
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Credential | M.D.
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Telephone | 734-242-2022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301036376
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License Number State | MI
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