Provider Demographics
NPI:1447253760
Name:QURESHI, TANVIR I (MD PC)
Entity type:Individual
Prefix:DR
First Name:TANVIR
Middle Name:I
Last Name:QURESHI
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 W. BROOKSHIRE COURT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3798
Mailing Address - Country:US
Mailing Address - Phone:734-242-5544
Mailing Address - Fax:734-457-6610
Practice Address - Street 1:5290 W. BROOKSHIRE COURT
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3798
Practice Address - Country:US
Practice Address - Phone:734-242-5544
Practice Address - Fax:734-457-6610
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI042971174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110184781OtherRR MEDICARE PROVIDER #
MIP40521OtherBCN
MI02894OtherPARAMOUNT PROVIDER #
MI1884958Medicaid
MI1105800181OtherBCBS PROVIDER#
MIP40521OtherBCN
MI0M78370Medicare ID - Type UnspecifiedMEDICARE PROVIDER #