Basic Information
| Provider Information | |||||||||
| NPI: | 1891078846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEHATA | ||||||||
| FirstName: | RAAFAT | ||||||||
| MiddleName: | BOLES MAHROUS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1239 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480991239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488246060 | ||||||||
| FaxNumber: | 2486860772 | ||||||||
| Practice Location | |||||||||
| Address1: | 21540 W 11 MILE RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480763843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483522000 | ||||||||
| FaxNumber: | 2483528800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2011 | ||||||||
| LastUpdateDate: | 10/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 4301099522 | MI | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | 4301099522 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.