1831176189 NPI number — DR. SHAZIA RAZA MD

Table of content: DR. SHAZIA RAZA MD (NPI 1831176189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831176189 NPI number — DR. SHAZIA RAZA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAZA
Provider First Name:
SHAZIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAMIM
Provider Other First Name:
SHAZIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831176189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4020 VENOY RD STE 700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48184-1891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-454-8001
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4020 VENOY RD STE 700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48184-1891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-454-8001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  4301091041 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1033514 . This is a "MCLAREN HEALTH ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1103313911 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200000016236 . This is a "PHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200000016236 . This is a "PHP-FAMILYCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 64071087 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1033514 . This is a "MCLAREN HEALTH PLAN-MEDICAID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00473883 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1033514 . This is a "MCLAREN HEALTH PLAN-COMMERCIAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1103313911 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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