1891188124 NPI number — HAMZAVI PSYCHIATRY & WELLNESS CENTER PLLC

Table of content: (NPI 1891188124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891188124 NPI number — HAMZAVI PSYCHIATRY & WELLNESS CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMZAVI PSYCHIATRY & WELLNESS CENTER PLLC
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:
1891188124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43151 DALCOMA DR
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48038-6306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-286-8720
Provider Business Mailing Address Fax Number:
586-649-6699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74 W LONG LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48304-2769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-731-7458
Provider Business Practice Location Address Fax Number:
248-731-7749
Provider Enumeration Date:
03/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HAMZAVI
Authorized Official First Name:
ASRA
Authorized Official Middle Name:
FATIMA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-731-7458

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  5101015643 , 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)





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