Provider Demographics
NPI:1538212485
Name:SHAREEFUDDIN, FAISAL M (MD)
Entity type:Individual
Prefix:
First Name:FAISAL
Middle Name:M
Last Name:SHAREEFUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376-1500
Mailing Address - Country:US
Mailing Address - Phone:248-592-5138
Mailing Address - Fax:248-592-5138
Practice Address - Street 1:11111 HALL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5711
Practice Address - Country:US
Practice Address - Phone:586-323-2181
Practice Address - Fax:586-323-2184
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFS082421208D00000X
MI4301082421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice