MEDICARE: ESSAM KHRAIZAT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	4301074776	MI

General Provider Information

NPI Number	:	1508846577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESSAM KHRAIZAT MD

Provider Business Mailing Address
First Line	:	6300 N HAGGERTY RD STE 200
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-4472
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 N HAGGERTY RD STE 200
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-4472
Country	:	US
Telephone Number	:	734-981-8181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	05/30/2017

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