Healthcare Provider Details

I. General information

NPI: 1902423767
Provider Name (Legal Business Name): MUHAMMAD SHERAZ RAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2020
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JEFFERSON AVE SE BLDG SUITE305
GRAND RAPIDS MI
49503-4502
US

IV. Provider business mailing address

200 JEFFERSON AVE SE BLDG SUITE305
GRAND RAPIDS MI
49503-4502
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-6774
  • Fax:
Mailing address:
  • Phone: 616-685-6774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351046584
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number4301509379
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: