Healthcare Provider Details

I. General information

NPI: 1578501508
Provider Name (Legal Business Name): MICHIGAN HOUSE PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

19727 ALLEN RD STE 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 Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IQBAL A NASIR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 734-479-8000