Provider Demographics
NPI:1174018634
Name:MEHDI, LARAIB (MD)
Entity type:Individual
Prefix:
First Name:LARAIB
Middle Name:
Last Name:MEHDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4373 OLD WEST AVE.
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ON
Mailing Address - Zip Code:N9G2W9
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4373 OLD WEST AVE.
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:ON
Practice Address - Zip Code:N9G2W9
Practice Address - Country:CA
Practice Address - Phone:519-254-3806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301504868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine