Provider Demographics
NPI:1245281435
Name:HAFEEZ, WASIF (MD)
Entity type:Individual
Prefix:
First Name:WASIF
Middle Name:
Last Name:HAFEEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5542 HOBNAIL CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1628
Mailing Address - Country:US
Mailing Address - Phone:313-592-3620
Mailing Address - Fax:313-592-3615
Practice Address - Street 1:22341 W 8 MILE RD
Practice Address - Street 2:SECOND FLOOR POD 4
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1217
Practice Address - Country:US
Practice Address - Phone:313-592-3620
Practice Address - Fax:313-592-3615
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIWH055371207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104788249Medicaid
MI0P129990Medicare ID - Type UnspecifiedMEDICARE GROUP
MI104788249Medicaid