Provider Demographics
NPI:1487192993
Name:PULMONARY, INTERNAL AND EMERGENCY MEDICINE AND RADIOLOGY ASSO
Entity Type:Organization
Organization Name:PULMONARY, INTERNAL AND EMERGENCY MEDICINE AND RADIOLOGY ASSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-358-4783
Mailing Address - Street 1:26699 W 12 MILE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1578
Mailing Address - Country:US
Mailing Address - Phone:248-358-4783
Mailing Address - Fax:248-359-1491
Practice Address - Street 1:26699 W 12 MILE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1578
Practice Address - Country:US
Practice Address - Phone:248-358-4783
Practice Address - Fax:248-359-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207P00000X, 207R00000X, 2085R0202X
207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty