Provider Demographics
NPI:1366516957
Name:AT HOME VISITING PHYSICIANS PC
Entity type:Organization
Organization Name:AT HOME VISITING PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-829-9188
Mailing Address - Street 1:23100 PROVIDENCE DRIVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:734-829-9188
Mailing Address - Fax:734-572-3228
Practice Address - Street 1:23100 PROVIDENCE DRIVE
Practice Address - Street 2:SUITE 216
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:734-829-9188
Practice Address - Fax:734-572-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty