Healthcare Provider Details

I. General information

NPI: 1356470355
Provider Name (Legal Business Name): S. TALIB RAZA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18025 FORT ST
RIVERVIEW MI
48193-7432
US

IV. Provider business mailing address

29495 PARKSIDE ST
FARMINGTON HILLS MI
48331-2668
US

V. Phone/Fax

Practice location:
  • Phone: 734-283-5555
  • Fax: 734-283-1600
Mailing address:
  • Phone: 248-489-1759
  • Fax: 734-283-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4301088026
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number4301088026
License Number StateMI

VIII. Authorized Official

Name: MR. SYED M. TALIB RAZA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-489-1759