Healthcare Provider Details

I. General information

NPI: 1225141328
Provider Name (Legal Business Name): NASSER RAZACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST
DETROIT MI
48201-2018
US

IV. Provider business mailing address

68 GLOBAL DR SUITE 100
GREENVILLE SC
29607-4628
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5111
  • Fax: 313-745-3500
Mailing address:
  • Phone: 864-644-2700
  • Fax: 864-644-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME92656
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2023020198
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME92656
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberME92656
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301081063
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: