Provider Demographics
NPI:1184854440
Name:ANWAR GHUZNAVI
Entity Type:Organization
Organization Name:ANWAR GHUZNAVI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:HUSSAIN
Authorized Official - Last Name:GHUZNAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-871-2300
Mailing Address - Street 1:11604 JOSEPH CAMPAU ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3045
Mailing Address - Country:US
Mailing Address - Phone:313-891-2300
Mailing Address - Fax:313-891-2300
Practice Address - Street 1:11604 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3045
Practice Address - Country:US
Practice Address - Phone:313-891-2300
Practice Address - Fax:313-891-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2098121Medicaid