Provider Demographics
NPI:1780655076
Name:OBEIDY, MONA Z (MD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:Z
Last Name:OBEIDY
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:DEPT 259301
Mailing Address - Street 2:P O BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2593
Mailing Address - Country:US
Mailing Address - Phone:734-467-4150
Mailing Address - Fax:734-467-4251
Practice Address - Street 1:116 S DENWOOD ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1310
Practice Address - Country:US
Practice Address - Phone:734-467-4150
Practice Address - Fax:734-467-4251
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2015-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301054803207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780655076Medicaid
MI1780655076Medicaid
MIN507200003Medicare PIN