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General NPI Number Information
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NPI Number | 1861439788
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Entity Type | Individual
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Provider Name | SHAZIA WADOOD MD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 12170 CONANT ST UNIT: C/2
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City | DETROIT
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State | MI
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Zip | 48212
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Country | US
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Telephone | 586-604-8108
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Fax |
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Provider Business Mailing Address
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Address Line | 12170 CONANT ST STE C2
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City | DETROIT
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State | MI
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Zip | 48212-4137
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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 | 4301079852
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301079852
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License Number State | MI
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