Healthcare Provider Details

I. General information

NPI: 1811953383
Provider Name (Legal Business Name): MIDHAT QIDWAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TORRANCE BLVD
TORRANCE CA
90503-4607
US

IV. Provider business mailing address

2923 BRADLEY ST STE 120
PASADENA CA
91107-1503
US

V. Phone/Fax

Practice location:
  • Phone: 310-548-5161
  • Fax:
Mailing address:
  • Phone: 310-548-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA86294
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA86294
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA86294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: