Provider Demographics
NPI:1831430909
Name:ADVANCED OB-GYN OF DEARBORN, P.C.
Entity type:Organization
Organization Name:ADVANCED OB-GYN OF DEARBORN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHAZALA
Authorized Official - Middle Name:AZAM
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-412-9552
Mailing Address - Street 1:2421 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3043
Mailing Address - Country:US
Mailing Address - Phone:313-447-0511
Mailing Address - Fax:313-447-0496
Practice Address - Street 1:2263 PINECROFT DR
Practice Address - Street 2:UNIT 216
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2247
Practice Address - Country:US
Practice Address - Phone:501-412-9552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center