Healthcare Provider Details

I. General information

NPI: 1003556770
Provider Name (Legal Business Name): DR. ZOHA NIZAMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 06/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST
DETROIT MI
48201-2153
US

IV. Provider business mailing address

4201 ST. ANTOINE ST., 9C-UHC
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5146
  • Fax: 313-993-8501
Mailing address:
  • Phone: 313-745-5146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL.5673R
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number4351054717
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: