Healthcare Provider Details

I. General information

NPI: 1861696882
Provider Name (Legal Business Name): NAZIA SADAF ADIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33155 ANNAPOLIS ST
WAYNE MI
48184-2405
US

IV. Provider business mailing address

49404 PINE RIDGE DR
PLYMOUTH MI
48170-6338
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-4000
  • Fax:
Mailing address:
  • Phone: 734-673-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301090082
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: