Basic Information
Provider Information
NPI: 1568025096
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PILEHVARI
FirstName: ZAHRA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2169 LOGAN DR
Address2:  
City: ROCHESTER HILLS
State: MI
PostalCode: 483094902
CountryCode: US
TelephoneNumber: 2488054250
FaxNumber:  
Practice Location
Address1: 4201 SAINT ANTOINE ST # 9C
Address2:  
City: DETROIT
State: MI
PostalCode: 482012153
CountryCode: US
TelephoneNumber: 3137455146
FaxNumber: 3139660880
Other Information
ProviderEnumerationDate: 04/19/2019
LastUpdateDate: 09/02/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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