Provider Demographics
NPI:1568951408
Name:NAFISA KUWAJERWALA MD PLLC
Entity Type:Organization
Organization Name:NAFISA KUWAJERWALA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NAFISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUWAJERWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-662-4333
Mailing Address - Street 1:26850 PROVIDENCE PKWY STE 504
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1267
Mailing Address - Country:US
Mailing Address - Phone:248-662-4333
Mailing Address - Fax:248-662-3022
Practice Address - Street 1:26850 PROVIDENCE PKWY STE 504
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1267
Practice Address - Country:US
Practice Address - Phone:248-662-4333
Practice Address - Fax:248-662-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077575208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301077575OtherLICENSE