Provider Demographics
NPI:1356363311
Name:KSEIBI, EIAD (MD)
Entity type:Individual
Prefix:DR
First Name:EIAD
Middle Name:
Last Name:KSEIBI
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 1:4973 CARLSON PARK DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4647
Mailing Address - Country:US
Mailing Address - Phone:248-722-8029
Mailing Address - Fax:
Practice Address - Street 1:7633 E JEFFERSON AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3730
Practice Address - Country:US
Practice Address - Phone:313-499-4985
Practice Address - Fax:313-499-4955
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077122207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1356363311Medicaid
MI700E012740OtherBCBS GROUP NUMBER
MI11-0502282-2OtherBCBS PIN NUMBER
MI0P22200Medicare PIN
MI0N40170Medicare PIN
MIP22200005Medicare PIN