Provider Demographics
NPI:1457301806
Name:BROHI, SHIREEN A (MD)
Entity Type:Individual
Prefix:
First Name:SHIREEN
Middle Name:A
Last Name:BROHI
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 1:1 FORD PLACE, HFHS. DEPT. OF FAMILY MEDICINE
Mailing Address - Street 2:2F 51
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3450
Mailing Address - Country:US
Mailing Address - Phone:313-876-8319
Mailing Address - Fax:
Practice Address - Street 1:1 FORD PLACE, HFHS, DEPT. OF MEDICINE
Practice Address - Street 2:2F 51
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3450
Practice Address - Country:US
Practice Address - Phone:313-876-8319
Practice Address - Fax:313-876-1302
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062399207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISB062399OtherBCBS OF MI
MI1758872Medicaid
MI4467930Medicaid
MI110245815OtherRAILROAD MEDICARE
MI700F325300OtherBCN
MIP00261667OtherRAILROAD MEDICARE
MI700F325300OtherBCN
MIQ24638035Medicare ID - Type Unspecified
MISB062399OtherBCBS OF MI
MI110245815OtherRAILROAD MEDICARE
MI4467930Medicaid