1851967079 NPI number — NAUREZ QASIM M.D.

Table of content: NAUREZ QASIM M.D. (NPI 1851967079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851967079 NPI number — NAUREZ QASIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QASIM
Provider First Name:
NAUREZ
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851967079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/28/2022
NPI Reactivation Date:
12/20/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DETROIT MEDICAL CENTER-SINAI GRACE HOSPITAL, DEPARTMENT
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-966-7434
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 W BELVEDERE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215-5270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-871-6831
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS1201X , with the licence number: D0099787 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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