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General NPI Number Information
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NPI Number | 1073998761
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Entity Type | Individual
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Provider Name | AHMAD FAWAZ
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Gender | Male
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 2241 ATLAS DR
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City | TROY
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State | MI
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Zip | 48083-2452
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Country | US
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Telephone | 248-835-5022
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 638257
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City | CINCINNATI
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State | OH
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Zip | 45263-8257
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Country | US
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Telephone | 888-952-6772
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704296870
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4707317809
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License Number State | MI
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