Healthcare Provider Details

I. General information

NPI: 1831176189
Provider Name (Legal Business Name): SHAZIA RAZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAZIA SHAMIM MD

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 VENOY RD STE 700
WAYNE MI
48184-1891
US

IV. Provider business mailing address

4020 VENOY RD STE 700
WAYNE MI
48184-1891
US

V. Phone/Fax

Practice location:
  • Phone: 734-454-8001
  • Fax:
Mailing address:
  • Phone: 734-454-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301091041
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: