Provider Demographics
NPI:1326227877
Name:HELEN ETEMADI DO PLLC
Entity Type:Organization
Organization Name:HELEN ETEMADI DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ETEMADI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-479-2100
Mailing Address - Street 1:14700 KING RD
Mailing Address - Street 2:STE. C
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7909
Mailing Address - Country:US
Mailing Address - Phone:734-479-2100
Mailing Address - Fax:
Practice Address - Street 1:14700 KING RD
Practice Address - Street 2:STE. C
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7909
Practice Address - Country:US
Practice Address - Phone:734-479-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012713207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty