1205024494 NPI number — M RAZI RAFEEQ MD INC

Table of content: (NPI 1205024494)

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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