Provider Demographics
NPI:1942504790
Name:NICOLAS MARSHEH, MD,PC
Entity Type:Organization
Organization Name:NICOLAS MARSHEH, MD,PC
Other - Org Name:FORUM MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPE
Authorized Official - Suffix:
Authorized Official - Credentials:BSHSA
Authorized Official - Phone:586-580-0282
Mailing Address - Street 1:44645 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1321
Mailing Address - Country:US
Mailing Address - Phone:586-580-0280
Mailing Address - Fax:586-580-0281
Practice Address - Street 1:44645 MOUND RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1321
Practice Address - Country:US
Practice Address - Phone:586-580-0280
Practice Address - Fax:586-580-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4862444Medicaid
H50177Medicare UPIN
0P1098Medicare PIN