Provider Demographics
NPI:1508094210
Name:QAQI, OSAMA MUSTAFA (MD)
Entity Type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:MUSTAFA
Last Name:QAQI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7633 E JEFFERSON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3732
Mailing Address - Country:US
Mailing Address - Phone:313-889-5100
Mailing Address - Fax:313-889-5101
Practice Address - Street 1:7633 E JEFFERSON AVE STE 200
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3732
Practice Address - Country:US
Practice Address - Phone:313-889-5100
Practice Address - Fax:313-889-5101
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010949888207R00000X
MI4301094988207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine