Provider Demographics
NPI:1376327171
Name:OMAR WAQHAR DO PSYCHIATRY SC
Entity Type:Organization
Organization Name:OMAR WAQHAR DO PSYCHIATRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:WAQHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-673-2937
Mailing Address - Street 1:1262 AZIZ DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-5094
Mailing Address - Country:US
Mailing Address - Phone:734-673-2937
Mailing Address - Fax:
Practice Address - Street 1:1262 AZIZ DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-5094
Practice Address - Country:US
Practice Address - Phone:734-673-2937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization