Provider Demographics
NPI:1669054417
Name:KADHIM, WAFAH JAWAD (MD)
Entity type:Individual
Prefix:
First Name:WAFAH
Middle Name:JAWAD
Last Name:KADHIM
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 1:1921 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-2402
Mailing Address - Country:US
Mailing Address - Phone:586-840-1333
Mailing Address - Fax:586-840-1377
Practice Address - Street 1:1921 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2402
Practice Address - Country:US
Practice Address - Phone:586-840-1333
Practice Address - Fax:586-840-1377
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301510936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine