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General NPI Number Information
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NPI Number | 1992734214
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Entity Type | Individual
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Provider Name | HAZEM SAMIR-MOEZ MD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 3301 HOLBROOK ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3519
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Country | US
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Telephone | 313-872-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 HOLBROOK ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3519
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Country | US
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Telephone | 313-872-5555
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Fax | 313-216-2770
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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 | 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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