Provider Demographics
NPI:1972563856
Name:GHUZNAVI, JASMIN (MD)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:GHUZNAVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43138 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314
Mailing Address - Country:US
Mailing Address - Phone:586-262-5060
Mailing Address - Fax:586-262-5061
Practice Address - Street 1:43138 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314
Practice Address - Country:US
Practice Address - Phone:586-262-5060
Practice Address - Fax:586-262-5061
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076244207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI024149OtherMIDWEST HEALTH PLAN
MI4732065Medicaid
MII23862Medicare UPIN
MI024149OtherMIDWEST HEALTH PLAN