Provider Demographics
NPI:1497060818
Name:MEMON, ANZA BILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANZA
Middle Name:BILAL
Last Name:MEMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANZA
Other - Middle Name:BILAL
Other - Last Name:MEMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:45095 BARTLETT DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2566
Mailing Address - Country:US
Mailing Address - Phone:248-238-0399
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST STE 8A
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-577-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010942842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology