Healthcare Provider Details

I. General information

NPI: 1922847359
Provider Name (Legal Business Name): HASSAN DRAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 06/06/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912
US

IV. Provider business mailing address

1322 E MICHIGAN AVE
LANSING MI
48912-2199
US

V. Phone/Fax

Practice location:
  • Phone: 734-496-5785
  • Fax:
Mailing address:
  • Phone: 734-496-5785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351052746
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: