MEDICARE: DR. FARZIN REZA NAMEI MD

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	207Q00000X	Family Medicine Physician	4301053449	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700E012740	OTHER	MI	BCBSM GROUP NUMBER

General Provider Information

NPI Number	:	1700883345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARZIN REZA NAMEI MD

Provider Business Mailing Address
First Line	:	24100 LITTLE MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-3247
Country	:	US
Telephone Number	:	586-443-4063
Fax Number	:	586-443-4064

Provider Business Practice Location Address
First Line	:	24100 LITTLE MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-3247
Country	:	US
Telephone Number	:	586-443-4063
Fax Number	:	586-443-4064

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	10/30/2008

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