Basic Information
Provider Information | |||||||||
NPI: | 1871040071 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | QURESHI | ||||||||
FirstName: | SEEMIN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TAJUDDIN | ||||||||
OtherFirstName: | SEEMIN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PA-C | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 6819 TRAILVIEW CT | ||||||||
Address2: |   | ||||||||
City: | WEST BLOOMFIELD | ||||||||
State: | MI | ||||||||
PostalCode: | 483224562 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7346580724 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1800 N MILFORD RD STE 100 | ||||||||
Address2: |   | ||||||||
City: | MILFORD | ||||||||
State: | MI | ||||||||
PostalCode: | 483811047 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2486846400 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/06/2016 | ||||||||
LastUpdateDate: | 07/27/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/14/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 5601007898 | MI | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 363AM0700X | 5601007898 | MI | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.