Provider Demographics
NPI:1215917133
Name:ETEMADI, HELEN (DO)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:ETEMADI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13331 MULBERRY TRL
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6345
Mailing Address - Country:US
Mailing Address - Phone:734-374-3132
Mailing Address - Fax:
Practice Address - Street 1:14450 KING RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7939
Practice Address - Country:US
Practice Address - Phone:734-479-2100
Practice Address - Fax:734-479-2199
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012713207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP2965001Medicare PIN
H17102Medicare UPIN