=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063735058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HASSAN AMIRIKIA MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2010
-----------------------------------------------------
Last Update Date | 08/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29877 TELEGRAPH RD SUITE 302
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034-1332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-353-8910
-----------------------------------------------------
Fax | 248-350-3519
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29877 TELEGRAPH RD SUITE 302
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034-1332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-353-8910
-----------------------------------------------------
Fax | 248-350-3519
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HASSAN AMIRIKIA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 248-353-8910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number | 4301031215
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 4301031215
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------