Provider Demographics
NPI:1679553838
Name:RATHUR, WASIM A (MD)
Entity type:Individual
Prefix:DR
First Name:WASIM
Middle Name:A
Last Name:RATHUR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:43900 GARFIELD RD STE 222
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1137
Mailing Address - Country:US
Mailing Address - Phone:586-286-0050
Mailing Address - Fax:586-286-0880
Practice Address - Street 1:42645 GARFIELD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5022
Practice Address - Country:US
Practice Address - Phone:586-286-0050
Practice Address - Fax:586-286-0880
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2018-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301063892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679553838Medicaid
MIMI3971Medicare PIN
MI4373656Medicaid