Provider Demographics
NPI:1780631671
Name:MICHIGAN INFECTION SPECIALISTS PLLC
Entity Type:Organization
Organization Name:MICHIGAN INFECTION SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BOXWALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-499-4255
Mailing Address - Street 1:7815 E JEFFERSON AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3704
Mailing Address - Country:US
Mailing Address - Phone:313-499-4255
Mailing Address - Fax:313-499-4913
Practice Address - Street 1:7815 E JEFFERSON AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3704
Practice Address - Country:US
Practice Address - Phone:313-499-4255
Practice Address - Fax:313-499-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N97420Medicare ID - Type Unspecified