Provider Demographics
NPI:1497741177
Name:IRANI, ARDESHIR (MD)
Entity Type:Individual
Prefix:DR
First Name:ARDESHIR
Middle Name:
Last Name:IRANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W HIGHLAND RD
Mailing Address - Street 2:STE 100
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48357-4504
Mailing Address - Country:US
Mailing Address - Phone:586-773-1823
Mailing Address - Fax:586-773-1211
Practice Address - Street 1:208 W HIGHLAND RD
Practice Address - Street 2:STE 100
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4504
Practice Address - Country:US
Practice Address - Phone:586-773-1823
Practice Address - Fax:586-773-1211
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-09
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
MIAI064238208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4343844Medicaid