Healthcare Provider Details

I. General information

NPI: 1962864108
Provider Name (Legal Business Name): RYAN HIJAZI D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30713 SCHOENHERR RD STE A
WARREN MI
48088-3122
US

IV. Provider business mailing address

30713 SCHOENHERR RD STE A
WARREN MI
48088-3122
US

V. Phone/Fax

Practice location:
  • Phone: 586-284-2643
  • Fax: 586-265-2170
Mailing address:
  • Phone: 586-284-2643
  • Fax: 586-265-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number5101026022
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: