Provider Demographics
NPI:1023169992
Name:SHEILA P MEFTAH, MD, PLLC
Entity type:Organization
Organization Name:SHEILA P MEFTAH, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEFTAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:248-737-2402
Mailing Address - Street 1:30349 KINGSWAY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1680
Mailing Address - Country:US
Mailing Address - Phone:248-737-2402
Mailing Address - Fax:248-737-2501
Practice Address - Street 1:33200 W 14 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3549
Practice Address - Country:US
Practice Address - Phone:248-737-2402
Practice Address - Fax:248-737-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407554174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106335411OtherBCBSMI
MI4148723Medicaid
MI377774OtherHAP
MI1106335411OtherBCBSMI
MI377774OtherHAP