Basic Information
| Provider Information | |||||||||
| NPI: | 1942339874 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAFEEZ | ||||||||
| FirstName: | NAZIMA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1195 PADDINGTON ROAD | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349816506 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2200 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436047101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192511400 | ||||||||
| FaxNumber: | 4192511797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 07/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301073258 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35.083468 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2836293 | 05 | OH | MEDICAID |