Provider Demographics
NPI:1659370815
Name:PRASAD MEFTAH, SHEILA (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:PRASAD MEFTAH
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 1:30349 KINGSWAY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1680
Mailing Address - Country:US
Mailing Address - Phone:248-737-2402
Mailing Address - Fax:248-737-2501
Practice Address - Street 1:33200 W 14 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3549
Practice Address - Country:US
Practice Address - Phone:248-737-2402
Practice Address - Fax:248-737-2501
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISM407554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383487089OtherCOMMERCIAL
MI1106335411OtherBCBS OF MI
MI414872310Medicaid
MI383487089OtherCOMMERCIAL
MIE77774Medicare UPIN