Healthcare Provider Details

I. General information

NPI: 1588584551
Provider Name (Legal Business Name): MOHAMMED MOAZAM QURESHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W UNIVERSITY DR
ROCHESTER MI
48307-1863
US

IV. Provider business mailing address

6464 PLANTERS PL
THOMASVILLE NC
27360-8928
US

V. Phone/Fax

Practice location:
  • Phone: 248-652-5000
  • Fax:
Mailing address:
  • Phone: 416-797-6771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351056411
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: