Provider Demographics
NPI:1134902307
Name:WASIM, UNKNOWN (MBBS/MD)
Entity type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:WASIM
Suffix:
Gender:M
Credentials:MBBS/MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4062 WEST 13 MILE ROAD
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-890-4250
Mailing Address - Fax:
Practice Address - Street 1:COREWELL HEALTH BEAUMONT HOSPITAL ROYAL OAK
Practice Address - Street 2:3601 WEST 13 MILE ROAD, INTERNAL MEDICINE-PEDIATRIC RES
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-898-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4351051792207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics