=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790031698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RINI SAHEWALLA M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2012
-----------------------------------------------------
Last Update Date | 10/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3901 BEAUBIEN ST PEDIATRICS EDUCATION OFFICE, THIRD FLOOR
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201-2119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-743-5427
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 751 LINCOLN LN 1403
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-6100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-510-5578
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0202X
-----------------------------------------------------
Taxonomy Name | Pediatric Cardiology Physician
-----------------------------------------------------
License Number | R7312
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 4301101367
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------