Healthcare Provider Details

I. General information

NPI: 1922288943
Provider Name (Legal Business Name): IQBAL A NASIR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19727 ALLEN RD SUITE 12
BROWNSTOWN TWP MI
48183-1188
US

IV. Provider business mailing address

19727 ALLEN RD SUITE 12
BROWNSTOWN TWP MI
48183-1188
US

V. Phone/Fax

Practice location:
  • Phone: 734-479-8000
  • Fax: 734-479-4812
Mailing address:
  • Phone: 734-479-8000
  • Fax: 734-479-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301058753
License Number StateMI

VIII. Authorized Official

Name: IQBAL A NASIR
Title or Position: OWNER
Credential: MD
Phone: 734-479-8000