Provider Demographics
NPI:1013086057
Name:MUAIAD SHIHADEH MD PC
Entity Type:Organization
Organization Name:MUAIAD SHIHADEH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MUAIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIHADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-434-8900
Mailing Address - Street 1:2236 PACKARD RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197
Mailing Address - Country:US
Mailing Address - Phone:734-459-7444
Mailing Address - Fax:
Practice Address - Street 1:2236 PACKARD RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-434-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICD5295OtherMEDICARE RAILROAD
MI1037130Medicaid
MI3045454Medicaid
MI110H110240OtherBLUE CROSS BLUE SHIELD
MICD5295OtherMEDICARE RAILROAD
MICD5295OtherMEDICARE RAILROAD