=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295014124
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEHDIA BADR HASHEMI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2011
-----------------------------------------------------
Last Update Date | 08/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 S HEALTH PKWY
-----------------------------------------------------
City | THREE RIVERS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49093-8358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-279-5240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7595 HAFLINGER CIR
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49009-3920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-978-0822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 4301082863
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------