Healthcare Provider Details

I. General information

NPI: 1083456396
Provider Name (Legal Business Name): ABDELRAHMAN IZRAIQI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/20/2025
Certification Date:
Deactivation Date: 01/16/2025
Reactivation Date: 06/20/2025

III. Provider practice location address

3535 W 13 MILE RD
ROYAL OAK MI
48073
US

IV. Provider business mailing address

COREWELL HEALTH WILLIAM BEAUMONT UNIVERSITY HOSPITAL 3535 W 13 MILE RD
ROYAL OAK MI
48073
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-3000
  • Fax: 248-551-3000
Mailing address:
  • Phone: 248-551-3000
  • Fax: 248-551-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351052401
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: