=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376327171
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMAR WAQHAR DO PSYCHIATRY SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2023
-----------------------------------------------------
Last Update Date | 08/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1262 AZIZ DR
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48188-5094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-673-2937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1262 AZIZ DR
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48188-5094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-673-2937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. OMAR WAQHAR
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 734-673-2937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------