Healthcare Provider Details

I. General information

NPI: 1447253760
Provider Name (Legal Business Name): TANVIR I QURESHI MD PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 W. BROOKSHIRE COURT
MONROE MI
48161-3798
US

IV. Provider business mailing address

5290 W. BROOKSHIRE COURT
MONROE MI
48161-3798
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-5544
  • Fax: 734-457-6610
Mailing address:
  • Phone: 734-242-5544
  • Fax: 734-457-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number042971
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: