Healthcare Provider Details

I. General information

NPI: 1770831497
Provider Name (Legal Business Name): RANDA AL BARAZI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST CHILDREN'S HOSPITAL OF MICHIGAN
DETROIT MI
48201
US

IV. Provider business mailing address

350 N MAIN ST UNIT 812
ROYAL OAK MI
48067-4122
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5848
  • Fax: 313-745-5848
Mailing address:
  • Phone: 917-439-9901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number4301100314
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: