Healthcare Provider Details

I. General information

NPI: 1578737219
Provider Name (Legal Business Name): SYED MOHAMMED HUSSAIN RAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2084 S LIVERNOIS RD
ROCHESTER HILLS MI
48307-3749
US

IV. Provider business mailing address

2084 S LIVERNOIS RD
ROCHESTER HILLS MI
48307-3749
US

V. Phone/Fax

Practice location:
  • Phone: 248-659-2861
  • Fax: 833-467-1525
Mailing address:
  • Phone: 248-659-2861
  • Fax: 833-467-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301088297
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number5315040199
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4301088297
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: