Provider Demographics
NPI:1891825071
Name:QAZI, AHSAN UL-HUQUE (MD)
Entity Type:Individual
Prefix:
First Name:AHSAN
Middle Name:UL-HUQUE
Last Name:QAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 N HIGHLAND SPRINGS AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3082
Mailing Address - Country:US
Mailing Address - Phone:951-845-8856
Mailing Address - Fax:951-845-7256
Practice Address - Street 1:264 N HIGHLAND SPRINGS AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3082
Practice Address - Country:US
Practice Address - Phone:951-845-8856
Practice Address - Fax:951-845-7256
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38621207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A386210Medicaid
CAA28672Medicare UPIN
CA00A386210Medicare ID - Type Unspecified