Provider Demographics
NPI:1487983730
Name:DEEB SHALHOUB, MD, PC
Entity type:Organization
Organization Name:DEEB SHALHOUB, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHMOEKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-479-1888
Mailing Address - Street 1:20965 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7951
Mailing Address - Country:US
Mailing Address - Phone:734-479-1888
Mailing Address - Fax:734-479-5058
Practice Address - Street 1:20965 GRANGE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7951
Practice Address - Country:US
Practice Address - Phone:734-479-1888
Practice Address - Fax:734-479-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS032484207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2104505Medicaid
MIE30677Medicare UPIN
MI2104505Medicaid