Provider Demographics
NPI:1861007106
Name:DR. WASFEH MUSHEINESH, P.C.
Entity Type:Organization
Organization Name:DR. WASFEH MUSHEINESH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/HEALTH CARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WASFEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSHEINESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-409-1441
Mailing Address - Street 1:2117 SPRINGWELLS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-1507
Mailing Address - Country:US
Mailing Address - Phone:313-409-1441
Mailing Address - Fax:
Practice Address - Street 1:2117 SPRINGWELLS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-1507
Practice Address - Country:US
Practice Address - Phone:313-409-1441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty