=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245430230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PONDVIEW PERSONAL PHYSICIAN PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2007
-----------------------------------------------------
Last Update Date | 09/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43207 POND VIEW DR
-----------------------------------------------------
City | STERLING HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48314-1890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-254-3924
-----------------------------------------------------
Fax | 586-254-3924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30236 JOHN R RD
-----------------------------------------------------
City | MADISON HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48071-5205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-399-1396
-----------------------------------------------------
Fax | 248-399-4119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ZAHID SHIEKH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 248-399-1396
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 4301058357
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------