Provider Demographics
NPI:1770641300
Name:MATHAI, SHEEJA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEEJA
Middle Name:
Last Name:MATHAI
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 1:2591 S LEATON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8421
Mailing Address - Country:US
Mailing Address - Phone:989-775-4672
Mailing Address - Fax:989-775-4680
Practice Address - Street 1:2591 S LEATON RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8421
Practice Address - Country:US
Practice Address - Phone:989-775-4672
Practice Address - Fax:989-775-4680
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086165207Q00000X
CT047253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400009257Medicare PIN