Healthcare Provider Details

I. General information

NPI: 1982684254
Provider Name (Legal Business Name): MOHAMMAD IMRAN QURESHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32804 PIERCE ST
BEVERLY HILLS MI
48025-3215
US

IV. Provider business mailing address

17177 N LAUREL PARK DR STE 439
LIVONIA MI
48152-3938
US

V. Phone/Fax

Practice location:
  • Phone: 248-864-8585
  • Fax: 248-864-8833
Mailing address:
  • Phone: 734-462-0340
  • Fax: 734-462-0344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301063802
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: