MEDICARE: MAMDOUH ABDULRAZZAK MD PC

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	2084N0400X	Neurology Physician	4301063026	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MI3232	OTHER	MI	MEDICARE

General Provider Information

NPI Number	:	1831403401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAMDOUH ABDULRAZZAK MD PC

Provider Business Mailing Address
First Line	:	PO BOX 250341
Second Line	:
City	:	FRANKLIN
State	:	MI
Zip	:	48025-0341
Country	:	US
Telephone Number	:	313-563-3332
Fax Number	:	313-563-3342

Provider Business Practice Location Address
First Line	:	3200 GREENFIELD RD
Second Line	:	SUITE 250
City	:	DEARBORN
State	:	MI
Zip	:	48120-1802
Country	:	US
Telephone Number	:	313-563-3332
Fax Number	:	313-563-3342

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAMDOUH ABDULRAZZAK
Credential	:	MD
Telephone Number	:	313-563-3332

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	11/22/2010

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