Provider Demographics
NPI:1992756167
Name:SHEHADEH, LAILA (DO)
Entity type:Individual
Prefix:
First Name:LAILA
Middle Name:
Last Name:SHEHADEH
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 1:14049 E 13 MILE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-5876
Mailing Address - Country:US
Mailing Address - Phone:586-558-9966
Mailing Address - Fax:586-558-5534
Practice Address - Street 1:14049 E 13 MILE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-5876
Practice Address - Country:US
Practice Address - Phone:586-558-9966
Practice Address - Fax:586-558-5534
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011421207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4475048Medicaid
MI4475048Medicaid
MION65790Medicare ID - Type UnspecifiedMEDICARE COMMON PROVIDER