Provider Demographics
NPI:1366414377
Name:HAQUE, NAZMUL (MD)
Entity type:Individual
Prefix:
First Name:NAZMUL
Middle Name:
Last Name:HAQUE
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 1:23900 ORCHARD LAKE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2500
Mailing Address - Country:US
Mailing Address - Phone:248-473-9429
Mailing Address - Fax:248-473-9200
Practice Address - Street 1:23900 ORCHARD LAKE RD STE 150
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2500
Practice Address - Country:US
Practice Address - Phone:248-987-6295
Practice Address - Fax:248-987-6296
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301065245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4600398-10Medicaid
G71843Medicare UPIN
MI4600398-10Medicaid