Healthcare Provider Details

I. General information

NPI: 1285908129
Provider Name (Legal Business Name): BABAR AZEEM QADRI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27177 LAHSER RD STE 203
SOUTHFIELD MI
48034-8468
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 734-414-9944
  • Fax: 862-298-0647
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006247
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: