Provider Demographics
NPI:1730464041
Name:TANVIR I QURESHI MD PC
Entity Type:Organization
Organization Name:TANVIR I QURESHI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TANVIR
Authorized Official - Middle Name:I
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MDPC
Authorized Official - Phone:734-242-5544
Mailing Address - Street 1:5290 W BROOKSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3798
Mailing Address - Country:US
Mailing Address - Phone:734-242-5544
Mailing Address - Fax:734-457-6610
Practice Address - Street 1:5290 W BROOKSHIRE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3798
Practice Address - Country:US
Practice Address - Phone:734-242-5544
Practice Address - Fax:734-457-6610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI042971261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB45542Medicare UPIN