Provider Demographics
NPI:1750304119
Name:PIRZADA, KHURRUM T (DO)
Entity Type:Individual
Prefix:DR
First Name:KHURRUM
Middle Name:T
Last Name:PIRZADA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 W AVON RD STE 13
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2760
Mailing Address - Country:US
Mailing Address - Phone:248-856-6656
Mailing Address - Fax:248-856-6657
Practice Address - Street 1:940 W AVON RD STE 13
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2760
Practice Address - Country:US
Practice Address - Phone:248-856-6656
Practice Address - Fax:248-856-6657
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4766671-11Medicaid
MIF36228179Medicare ID - Type Unspecified
MIH72847Medicare UPIN