Provider Demographics
NPI:1851779797
Name:SHATILA, MOUHAMED OSMAN (DO)
Entity Type:Individual
Prefix:
First Name:MOUHAMED
Middle Name:OSMAN
Last Name:SHATILA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39650 ORCHARD HILL PL STE 100
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5392
Mailing Address - Country:US
Mailing Address - Phone:248-449-7010
Mailing Address - Fax:248-449-7015
Practice Address - Street 1:39650 ORCHARD HILL PL STE 100
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5392
Practice Address - Country:US
Practice Address - Phone:248-449-7010
Practice Address - Fax:248-449-7015
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021657207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty