Healthcare Provider Details

I. General information

NPI: 1083605877
Provider Name (Legal Business Name): ROXANA HAKIMZADEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BARCLAY CIR SUITE 100
ROCHESTER HILLS MI
48307-5820
US

IV. Provider business mailing address

75 BARCLAY CIR SUITE 100
ROCHESTER HILLS MI
48307-5820
US

V. Phone/Fax

Practice location:
  • Phone: 248-856-6500
  • Fax: 248-856-6504
Mailing address:
  • Phone: 248-856-6500
  • Fax: 248-856-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301064286
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: