Provider Demographics
NPI:1275509994
Name:GHAZALA A BURNEY MD PLLC
Entity Type:Organization
Organization Name:GHAZALA A BURNEY MD PLLC
Other - Org Name:DR GHAZALA BURNEY AHMAD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHAZALA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNEY AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-421-0705
Mailing Address - Street 1:35300 NANKIN BLVD
Mailing Address - Street 2:STE 603
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185
Mailing Address - Country:US
Mailing Address - Phone:734-421-0705
Mailing Address - Fax:734-421-2029
Practice Address - Street 1:35300 NANKIN BLVD
Practice Address - Street 2:STE 603
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185
Practice Address - Country:US
Practice Address - Phone:734-421-0705
Practice Address - Fax:734-421-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064815207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E76849Medicare UPIN
MIOM82550Medicare ID - Type Unspecified