MEDICARE: DR. MOHAMAD HAZEM RASLAN M.D

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	207RP1001X	Pulmonary Disease Physician	MR057633	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200449690	OTHER	MI	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619938768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMAD HAZEM RASLAN M.D

Provider Business Mailing Address
First Line	:	PO BOX 253044
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48325-3044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 N HAGGERTY RD STE 210
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-4472
Country	:	US
Telephone Number	:	734-641-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	02/19/2024

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