Provider Demographics
NPI:1174553770
Name:NESHEWAT, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:NESHEWAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HERITAGE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3000
Mailing Address - Country:US
Mailing Address - Phone:734-283-3222
Mailing Address - Fax:734-283-4006
Practice Address - Street 1:3 HERITAGE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3000
Practice Address - Country:US
Practice Address - Phone:734-283-3222
Practice Address - Fax:734-283-4006
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine