Provider Demographics
NPI:1073992012
Name:PERVAIZ, AMINA (MD)
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:
Last Name:PERVAIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 ST ANTOINE 2E
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-4832
Mailing Address - Fax:313-745-4052
Practice Address - Street 1:4201 ST. ANTOINE 2E
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-4832
Practice Address - Fax:313-745-4052
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2022-02-03
Deactivation Date:2016-01-13
Deactivation Code:
Reactivation Date:2016-03-15
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301505482207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program