1356470355 NPI number — S. TALIB RAZA, P.C.

Table of content: (NPI 1356470355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356470355 NPI number — S. TALIB RAZA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S. TALIB RAZA, P.C.
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:
1356470355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29495 PARKSIDE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48331-2668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-489-1759
Provider Business Mailing Address Fax Number:
734-283-5555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18025 FORT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERVIEW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48193-7432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-283-5555
Provider Business Practice Location Address Fax Number:
734-283-1600
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAZA
Authorized Official First Name:
SYED
Authorized Official Middle Name:
M. TALIB
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-489-1759

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  4301088026 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RS0012X , with the licence number: 4301088026 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0H27304 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1235106915 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com