Provider Demographics
NPI:1245430230
Name:PONDVIEW PERSONAL PHYSICIAN PC
Entity Type:Organization
Organization Name:PONDVIEW PERSONAL PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIEKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-399-1396
Mailing Address - Street 1:30236 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5205
Mailing Address - Country:US
Mailing Address - Phone:248-399-1396
Mailing Address - Fax:248-399-4119
Practice Address - Street 1:43207 POND VIEW DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1890
Practice Address - Country:US
Practice Address - Phone:586-254-3924
Practice Address - Fax:586-254-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058357261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0808285921OtherBCBSM
0P29320Medicare PIN
F70666Medicare UPIN