Aqsa Pervez, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4351049279 Issued in MI

Practice address

36500 S Gratiot Ave Ste 102
Clinton Township, MI 48035-1772

Phone

(586) 790-9003

Fax

(586) 493-3603

NPI assigned

Mar 29, 2022

Last updated

Jul 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: apervez1087717@direct.hfhs.org
• Direct secure messaging: aqsa.pervez.1@16555.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1174273395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36500 S GRATIOT AVE STE 102",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480351772",
            "telephone_number": "586-790-9003",
            "fax_number": "586-493-3603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36500 S GRATIOT AVE STE 102",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480351772",
            "telephone_number": "586-790-9003",
            "fax_number": "586-493-3603"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Harrington St",
            "address_purpose": "LOCATION",
            "city": "Mount Clemens",
            "state": "MI",
            "postal_code": "480432920",
            "country_code": "US",
            "telephone_number": "586-493-8749",
            "fax_number": "586-493-3250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERVEZ",
        "first_name": "AQSA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-29",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4351049279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Clinton Township, MI
• Providers in Clinton Township, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.