1205024494 NPI number — M RAZI RAFEEQ MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205024494 NPI number — M RAZI RAFEEQ MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M RAZI RAFEEQ MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205024494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 ISAAC STREETS DR STE 128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OREGON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43616-3243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-693-2230
Provider Business Mailing Address Fax Number:
419-693-2602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 ISAAC STREETS DR STE 128
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREGON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43616-3243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-693-2230
Provider Business Practice Location Address Fax Number:
419-693-2602
Provider Enumeration Date:
10/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GELACEK
Authorized Official First Name:
SUEANN
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
419-693-2230

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  35047541R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 206565077002 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4836490 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600655 . This is a "BUCKEYE COMMUNITY HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000137276 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 00088 . This is a "PARAMOUNT HEALTH CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0493756 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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