Provider Demographics
NPI:1245325257
Name:ELSHIEKH, ELTAYEB H (MD)
Entity type:Individual
Prefix:
First Name:ELTAYEB
Middle Name:H
Last Name:ELSHIEKH
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 1:26901 BEAUMONT BLVD
Mailing Address - Street 2:STE 3D
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:701-780-5000
Mailing Address - Fax:
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-898-7999
Practice Address - Fax:248-898-0580
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247847207R00000X
IN01062573A207R00000X, 208M00000X
ND10388207R00000X, 208M00000X
ND11910208M00000X
MI4301502947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000553121OtherANTHEM
IN000000600893OtherANTHEM PROVIDER NUMBER / GROUP ARNETT CLINIC, LLC
INP00478522OtherRAILROAD MEDICARE
IN200889470Medicaid
IN4630876OtherAETNA
IN4630876OtherAETNA
IN070860UUUUMedicare PIN
IN200889470Medicaid