Provider Demographics
NPI:1609142900
Name:ZEIA CASAB RUEDA MD
Entity Type:Organization
Organization Name:ZEIA CASAB RUEDA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-656-2150
Mailing Address - Street 1:1320 WILKINS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4802
Mailing Address - Country:US
Mailing Address - Phone:313-656-2150
Mailing Address - Fax:313-656-2152
Practice Address - Street 1:5662 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2158
Practice Address - Country:US
Practice Address - Phone:313-841-3310
Practice Address - Fax:313-841-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033492207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2825728Medicaid
MI2825728Medicaid
MI7820009Medicare PIN