Provider Demographics
NPI:1962423657
Name:MARSHEH, NICOLAS ATIF (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:ATIF
Last Name:MARSHEH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43184 DEQUINDRE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1709
Mailing Address - Country:US
Mailing Address - Phone:586-580-0280
Mailing Address - Fax:586-580-0281
Practice Address - Street 1:43184 DEQUINDRE RD STE 202
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1709
Practice Address - Country:US
Practice Address - Phone:586-580-0280
Practice Address - Fax:586-580-0281
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E00984OtherBCBS
MINM 069838OtherSTATE LISCENCE NUMBER
MI4732824Medicaid
MI1106348002OtherBLUE CROSS BLUE SHIELD
MI4301069838OtherCONTOLLED SUBSTANCE
MI20-2076304OtherTAX ID
MI23D1050828OtherCLIA
MIBM 6597352OtherDEA
MI4301069838OtherCONTOLLED SUBSTANCE
MIP10980001Medicare PIN