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General NPI Number Information
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NPI Number | 1669680385
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Entity Type | Individual
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Provider Name | MEHBOOB M QURESHI MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 2514 S 102ND ST SUITE 160
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City | WEST ALLIS
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State | WI
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Zip | 53227-2142
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Country | US
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Telephone | 414-255-0300
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Fax | 414-543-9601
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Provider Business Mailing Address
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Address Line | PO BOX 1239
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City | TROY
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State | MI
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Zip | 48099-1239
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Country | US
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Telephone | 248-824-6600
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Fax | 248-324-1477
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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 | 16658-020
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License Number State | WI
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