Provider Demographics
NPI:1013980531
Name:KASMIKHA, RIYADH P (MD)
Entity type:Individual
Prefix:DR
First Name:RIYADH
Middle Name:P
Last Name:KASMIKHA
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 1:28500 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2722
Mailing Address - Country:US
Mailing Address - Phone:248-440-2185
Mailing Address - Fax:248-440-2189
Practice Address - Street 1:28500 SOUTHFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2722
Practice Address - Country:US
Practice Address - Phone:248-440-2185
Practice Address - Fax:248-440-2189
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4453274Medicaid
MI0N71580Medicare ID - Type Unspecified
MI4453274Medicaid