Provider Demographics
NPI:1194160002
Name:FARSHADSEFAT, SEINA (DO)
Entity type:Individual
Prefix:
First Name:SEINA
Middle Name:
Last Name:FARSHADSEFAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11885 E 12 MILE RD STE 300A
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3467
Mailing Address - Country:US
Mailing Address - Phone:586-582-6630
Mailing Address - Fax:586-582-6631
Practice Address - Street 1:1555 SOUTH BLVD E STE 320
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5624
Practice Address - Country:US
Practice Address - Phone:248-651-0800
Practice Address - Fax:248-651-7341
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine