Provider Demographics
NPI:1235305053
Name:SOUDABEH AHADI MD PC
Entity Type:Organization
Organization Name:SOUDABEH AHADI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOUDABEH
Authorized Official - Middle Name:
Authorized Official - Last Name:AHADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-242-2022
Mailing Address - Street 1:55 COLE ROAD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162
Mailing Address - Country:US
Mailing Address - Phone:734-242-2022
Mailing Address - Fax:734-242-2251
Practice Address - Street 1:55 COLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4103
Practice Address - Country:US
Practice Address - Phone:734-242-2022
Practice Address - Fax:734-242-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036376207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1096347Medicaid
MI05810281OtherBCBS
MI1096347Medicaid
MI0583111016Medicare PIN