Healthcare Provider Details

I. General information

NPI: 1780631671
Provider Name (Legal Business Name): MICHIGAN INFECTION SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7815 E JEFFERSON AVE SUITE 2C
DETROIT MI
48214-3704
US

IV. Provider business mailing address

7815 E JEFFERSON AVE SUITE 2C
DETROIT MI
48214-3704
US

V. Phone/Fax

Practice location:
  • Phone: 313-499-4255
  • Fax: 313-499-4913
Mailing address:
  • Phone: 313-499-4255
  • Fax: 313-499-4913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ASGAR BOXWALLA
Title or Position: PRESIDENT
Credential: MD
Phone: 313-499-4255