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General NPI Number Information
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NPI Number | 1467682443
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Entity Type | Individual
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Provider Name | MIHAI ILIESIU MD
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Gender | Male
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 27483 DEQUINDRE RD STE 210
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-5711
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Country | US
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Telephone | 248-398-4081
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Fax | 248-398-4527
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Provider Business Mailing Address
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Address Line | 29992 NORTHWESTERN HWY STE C
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-3292
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Country | US
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Telephone | 248-851-1430
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Fax | 248-851-5182
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 4301094974
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 4301094974
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License Number State | MI
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