Provider Demographics
NPI:1164988903
Name:QURESHI, MUBEEN EJAZ
Entity Type:Individual
Prefix:
First Name:MUBEEN
Middle Name:EJAZ
Last Name:QURESHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35053 VITO DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5043
Mailing Address - Country:US
Mailing Address - Phone:586-207-7680
Mailing Address - Fax:
Practice Address - Street 1:35053 VITO DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5043
Practice Address - Country:US
Practice Address - Phone:586-207-7680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011038391041C0700X
MI68011102371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical