Provider Demographics
NPI:1629690565
Name:GONDAL, FASEEHA ARSHAD (MD)
Entity Type:Individual
Prefix:MS
First Name:FASEEHA
Middle Name:ARSHAD
Last Name:GONDAL
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:DETROIT EDUCATION & RESEARCH GRADUATE MEDICAL EDUCATIO
Mailing Address - Street 2:4201 ST ANTOINE ST., 9C-UHC DETROIT, MICHIGAN 48201
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-0463
Mailing Address - Fax:
Practice Address - Street 1:DETROIT MEDICAL CENTER SINAI GRACE HOSPITAL
Practice Address - Street 2:6071 OUTER DR W. DETROIT, MI 48235, UNITED STATES
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-966-7434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2023-07-11
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-02-24
Provider Licenses
StateLicense IDTaxonomies
WAMD61416032207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program