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General NPI Number Information
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NPI Number | 1467517862
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Entity Type | Organization
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Legal Business Name | HAMTRAMCK MEDICAL GROUP, PC
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9222 JOSEPH CAMPAU ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3731
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Country | US
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Telephone | 313-872-5555
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Fax | 313-872-5009
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Provider Business Mailing Address
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Address Line | 27141 KENNEDY ST
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-1669
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Country | US
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Telephone | 313-410-2010
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Fax | 313-561-6666
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. HAZEM SAMIR-MOEZ
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Credential | MD
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Telephone | 313-410-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301063463
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License Number State | MI
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