Provider Demographics
NPI:1376642744
Name:WASIM A QAZI MD PC
Entity Type:Organization
Organization Name:WASIM A QAZI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-341-2545
Mailing Address - Street 1:6001 W OUTER DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2614
Mailing Address - Country:US
Mailing Address - Phone:313-341-2545
Mailing Address - Fax:
Practice Address - Street 1:6001 W OUTER DR
Practice Address - Street 2:SUITE 420
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2614
Practice Address - Country:US
Practice Address - Phone:313-341-2545
Practice Address - Fax:313-341-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104252490Medicaid
MI0826370OtherBLUE SHIELD
MI0N99650Medicare ID - Type Unspecified