Provider Demographics
NPI:1215069604
Name:QURESHI, SARWAR DIN (RPT PHD)
Entity type:Individual
Prefix:
First Name:SARWAR
Middle Name:DIN
Last Name:QURESHI
Suffix:
Gender:M
Credentials:RPT PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13855 W 9 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2775
Mailing Address - Country:US
Mailing Address - Phone:248-703-6088
Mailing Address - Fax:248-548-6580
Practice Address - Street 1:13855 W 9 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2775
Practice Address - Country:US
Practice Address - Phone:248-703-6088
Practice Address - Fax:248-548-6580
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236651Medicare ID - Type Unspecified