Provider Demographics
NPI:1487008108
Name:SADEGHI, MAHSA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MAHSA
Middle Name:
Last Name:SADEGHI
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 1:6071 WEST OUTER DRIVE-M408
Mailing Address - Street 2:SINAI-GRACE HOSPITAL,
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6071 WEST OUTER DRIVE-M408
Practice Address - Street 2:SINAI-GRACE HOSPITAL,
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-966-1728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2017-02-08
Deactivation Date:2016-12-21
Deactivation Code:
Reactivation Date:2017-02-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program