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General NPI Number Information
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NPI Number | 1013765452
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Entity Type | Individual
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Provider Name | SABA AL-QAWASMI
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Gender | Female
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Dates
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Enumeration Date | 05/10/2024
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 35169 E MICHIGAN AVE
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City | WAYNE
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State | MI
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Zip | 48184-1660
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Country | US
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Telephone | 734-728-5940
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Fax |
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Provider Business Mailing Address
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Address Line | 41434 W VILLAGE GREEN BLVD APT 201
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City | CANTON
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State | MI
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Zip | 48187-3864
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Country | US
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Telephone | 708-745-8979
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901005803
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License Number State | MI
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