Basic Information
| Provider Information | |||||||||
| NPI: | 1275553638 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANWAR | ||||||||
| FirstName: | TAIMUR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6550 W WARREN AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482101134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138977700 | ||||||||
| FaxNumber: | 3138975991 | ||||||||
| Practice Location | |||||||||
| Address1: | 6550 W WARREN AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482101134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138977700 | ||||||||
| FaxNumber: | 3138975991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 02/21/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301077003 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 4583976 | 05 | MI | MEDICAID | TA077003 | 01 | MI | BCBS OF MICHIGAN | OTHER |