Provider Demographics
NPI:1740406263
Name:GHINWA NAKKASH, MD PC
Entity Type:Organization
Organization Name:GHINWA NAKKASH, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-526-9999
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-0279
Mailing Address - Country:US
Mailing Address - Phone:248-526-9999
Mailing Address - Fax:248-526-9089
Practice Address - Street 1:1899 E WATTLES RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-5082
Practice Address - Country:US
Practice Address - Phone:248-526-9999
Practice Address - Fax:248-526-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty