Healthcare Provider Details

I. General information

NPI: 1346548302
Provider Name (Legal Business Name): HARVEY LEE RAIMI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N CASS LAKE RD STE 112
WATERFORD MI
48328-2370
US

IV. Provider business mailing address

6235 NW 42ND WAY BOCA RATON
BOCA RATON FL
33496-4036
US

V. Phone/Fax

Practice location:
  • Phone: 248-683-8050
  • Fax: 561-994-1296
Mailing address:
  • Phone: 248-210-1051
  • Fax: 561-994-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR-6205
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: