Provider Demographics
NPI:1104346634
Name:WASEEM G PETROS MD PLLC
Entity type:Organization
Organization Name:WASEEM G PETROS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WASEEM
Authorized Official - Middle Name:GHANIM
Authorized Official - Last Name:PETROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-250-8233
Mailing Address - Street 1:2221 LIVERNOIS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1603
Mailing Address - Country:US
Mailing Address - Phone:248-250-8233
Mailing Address - Fax:248-250-9483
Practice Address - Street 1:2221 LIVERNOIS RD STE 100
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-250-9474
Practice Address - Fax:248-250-9483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301105506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty