MEDICARE: SUBAN M RAZACK M D INC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881727766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUBAN M RAZACK M D INC

Provider Business Mailing Address
First Line	:	1134 BROWN ST STE 1B
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44301-1964
Country	:	US
Telephone Number	:	330-724-1215
Fax Number	:

Provider Business Practice Location Address
First Line	:	1134 BROWN ST
Second Line	:	SUITE 1B
City	:	AKRON
State	:	OH
Zip	:	44301-1964
Country	:	US
Telephone Number	:	330-724-1215
Fax Number	:	330-724-0699

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. SUBAN MOHAMED RAZACK
Credential	:	MD
Telephone Number	:	330-724-1215

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	12/07/2007

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