Provider Demographics
NPI:1245503788
Name:KISHI, EMAD (MD)
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:
Last Name:KISHI
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 1:29478 JUNEAU LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2751
Mailing Address - Country:US
Mailing Address - Phone:857-265-5600
Mailing Address - Fax:
Practice Address - Street 1:22101 MOROSS RD STE 480
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2148
Practice Address - Country:US
Practice Address - Phone:313-343-3048
Practice Address - Fax:313-343-7349
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME135627204F00000X
SCAL37466204F00000X
MI4301505425208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery