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General NPI Number Information
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NPI Number | 1124448113
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Entity Type | Individual
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Provider Name | ABDUL MALIK QAVI D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 3031 W GRAND BLVD SUITE 450
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City | DETROIT
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State | MI
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Zip | 48202-3046
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Country | US
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Telephone | 586-258-8169
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Fax |
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Provider Business Mailing Address
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Address Line | 8167 BAY CT
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City | TEMPERANCE
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State | MI
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Zip | 48182-9157
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34012967
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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