Provider Demographics
NPI:1063423176
Name:ISHAQSEI, WAHED (MD)
Entity type:Individual
Prefix:DR
First Name:WAHED
Middle Name:
Last Name:ISHAQSEI
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 1:18263 E 10 MILE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-5805
Mailing Address - Country:US
Mailing Address - Phone:586-778-4950
Mailing Address - Fax:586-778-4952
Practice Address - Street 1:18263 E 10 MILE RD
Practice Address - Street 2:SUITE D
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5805
Practice Address - Country:US
Practice Address - Phone:586-778-4950
Practice Address - Fax:586-778-4952
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4030080522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E012740OtherBCBSM GROUP NUMBER
MIWI080522OtherMI LICENSE
MI5223439Medicaid
MI5212168Medicaid
MI5223439Medicaid
MI5212168Medicaid