MEDICARE: MICHIGAN WOMEN'S CARE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician		MI

General Provider Information

NPI Number	:	1174630115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN WOMEN'S CARE, PLLC

Provider Business Mailing Address
First Line	:	6300 N HAGGERTY ROAD
Second Line	:	SUITE 200
City	:	CANTON
State	:	MI
Zip	:	48187-3338
Country	:	US
Telephone Number	:	734-981-8181
Fax Number	:	734-981-1259

Provider Business Practice Location Address
First Line	:	6300 N HAGGERTY RD STE 200
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-4472
Country	:	US
Telephone Number	:	734-981-8181
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ESSAM KHRAIZAT
Credential	:	M.D.
Telephone Number	:	248-470-6122

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/21/2022

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