Provider Demographics
NPI:1144366758
Name:SAMINA ANSAR GHAZI MD PC
Entity type:Organization
Organization Name:SAMINA ANSAR GHAZI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMINA
Authorized Official - Middle Name:ANSAR
Authorized Official - Last Name:GHAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-489-9070
Mailing Address - Street 1:28907 E KING WILLIAM DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2579
Mailing Address - Country:US
Mailing Address - Phone:248-553-2886
Mailing Address - Fax:
Practice Address - Street 1:33110 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3307
Practice Address - Country:US
Practice Address - Phone:248-489-9070
Practice Address - Fax:248-489-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060000261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4495327-10Medicaid
MION64120Medicare ID - Type Unspecified
MIH61651Medicare UPIN