Provider Demographics
NPI:1992754980
Name:GHAZI, SAMINA ANSAR (MD)
Entity type:Individual
Prefix:DR
First Name:SAMINA
Middle Name:ANSAR
Last Name:GHAZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMINA
Other - Middle Name:
Other - Last Name:ANSAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:33110 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3307
Mailing Address - Country:US
Mailing Address - Phone:248-489-9070
Mailing Address - Fax:248-489-9076
Practice Address - Street 1:33110 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3307
Practice Address - Country:US
Practice Address - Phone:248-489-9070
Practice Address - Fax:248-489-9076
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI449532710Medicaid
MION64120Medicare ID - Type Unspecified