Healthcare Provider Details

I. General information

NPI: 1295780989
Provider Name (Legal Business Name): FASAHAT HUSAIN HAMZAVI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43151 DALCOMA DR SUITE 1
CLINTON TWP MI
48038-6306
US

IV. Provider business mailing address

43151 DALCOMA DR SUITE 1
CLINTON TWP MI
48038-6306
US

V. Phone/Fax

Practice location:
  • Phone: 586-286-8720
  • Fax: 586-286-8723
Mailing address:
  • Phone: 586-286-8720
  • Fax: 586-286-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberFH078231
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: