Healthcare Provider Details

I. General information

NPI: 1972354637
Provider Name (Legal Business Name): AYSHA QAMAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S CANTON CENTER RD
CANTON MI
48188-1992
US

IV. Provider business mailing address

37595 7 MILE RD STE 210
LIVONIA MI
48152-1489
US

V. Phone/Fax

Practice location:
  • Phone: 734-844-8743
  • Fax: 734-844-8744
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101029637
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: