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General NPI Number Information
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NPI Number | 1023131547
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Entity Type | Individual
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Provider Name | ABDUL RAZZAK MAHFOUZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 24230 KARIM BLBD SUITE# 125
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City | NOVI
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State | MI
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Zip | 48375-2960
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Country | US
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Telephone | 248-474-2700
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Fax | 248-474-2721
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Provider Business Mailing Address
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Address Line | 3350 PARKLAND DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-1828
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Country | US
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Telephone | 248-851-0514
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Fax | 248-851-7133
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301033059
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License Number State | MI
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