Basic Information
| Provider Information | |||||||||
| NPI: | 1205272598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QURESHI | ||||||||
| FirstName: | SABA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6438 WILMINGTON PIKE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454597022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375583840 | ||||||||
| FaxNumber: | 9375583844 | ||||||||
| Practice Location | |||||||||
| Address1: | 6438 WILMINGTON PIKE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454597022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375583840 | ||||||||
| FaxNumber: | 9375583844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2013 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 35129565 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0183476 | 05 | OH | MEDICAID |