Provider Demographics
NPI:1578050563
Name:BEENISH, UROOJ (MD)
Entity Type:Individual
Prefix:MRS
First Name:UROOJ
Middle Name:
Last Name:BEENISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:UROOJ
Other - Middle Name:
Other - Last Name:BEENISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 N CALEDONIA DR
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-8844
Mailing Address - Country:US
Mailing Address - Phone:248-252-9164
Mailing Address - Fax:
Practice Address - Street 1:200 N CALEDONIA DR
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-8844
Practice Address - Country:US
Practice Address - Phone:989-729-4848
Practice Address - Fax:989-729-4849
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2021-05-05
Deactivation Date:2018-11-28
Deactivation Code:
Reactivation Date:2018-12-10
Provider Licenses
StateLicense IDTaxonomies
MI4301503323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine