Individual
SHAZIA WADOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12170 CONANT ST, UNIT: C/2, DETROIT, MI 48212
(586) 604-8108
Mailing address
12170 CONANT ST, STE C2, DETROIT, MI 48212-4137
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301079852
MI
208000000X
Pediatrics Physician
Primary
4301079852
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
491643810
—
MI
Enumeration date
05/31/2006
Last updated
05/16/2018
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