Provider Demographics
NPI:1871667071
Name:DEMASHKIEH, WALID (MD)
Entity Type:Individual
Prefix:DR
First Name:WALID
Middle Name:
Last Name:DEMASHKIEH
Suffix:
Gender:M
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:PO BOX 610669
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48061-0669
Mailing Address - Country:US
Mailing Address - Phone:810-985-1884
Mailing Address - Fax:810-966-3025
Practice Address - Street 1:2609 ELECTRIC AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6589
Practice Address - Country:US
Practice Address - Phone:810-984-1148
Practice Address - Fax:810-984-1149
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039123208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4061902OtherAETNA
MI0740003OtherBCBS
MI2640474 TYPE 10Medicaid
4061902OtherAETNA
CARE CHOICEOther101572
A76346OtherHAP
MIA76346Medicare UPIN