Provider Demographics
NPI:1023044542
Name:DOWNRIVER SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:DOWNRIVER SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IQBAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NASIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-479-8000
Mailing Address - Street 1:19727 ALLEN RD
Mailing Address - Street 2:STE 12
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1188
Mailing Address - Country:US
Mailing Address - Phone:734-479-8000
Mailing Address - Fax:734-479-4812
Practice Address - Street 1:19727 ALLEN RD
Practice Address - Street 2:STE 12
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1188
Practice Address - Country:US
Practice Address - Phone:734-479-8000
Practice Address - Fax:734-479-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4978127Medicaid
MI4978109Medicaid
MI4978136Medicaid
MI4978127Medicaid