MEDICARE: RAZIUDDIN AHMED DPM

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	213E00000X	Podiatrist	E 4483	CA
2	213E00000X	Podiatrist	RA002029	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00348699	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5802579	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1972506293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAZIUDDIN AHMED DPM

Provider Business Mailing Address
First Line	:	10570 BLUE STAR M HWY
Second Line	:
City	:	SOUTH HAVEN
State	:	MI
Zip	:	49090-8923
Country	:	US
Telephone Number	:	269-978-3385
Fax Number	:	269-978-2711

Provider Business Practice Location Address
First Line	:	10570 BLUE STAR M HWY
Second Line	:
City	:	SOUTH HAVEN
State	:	MI
Zip	:	49090-8923
Country	:	US
Telephone Number	:	269-978-3385
Fax Number	:	269-978-2711

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/29/2009

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Directions to “ RAZIUDDIN AHMED DPM” Practice Location

Language	Start Address	Practice Location

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