Provider Demographics
NPI:1053318170
Name:ALZAGOUM, MAJID (MD)
Entity Type:Individual
Prefix:DR
First Name:MAJID
Middle Name:
Last Name:ALZAGOUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18303 E 10 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4988
Mailing Address - Country:US
Mailing Address - Phone:586-776-8877
Mailing Address - Fax:586-776-3092
Practice Address - Street 1:18303 E 10 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4988
Practice Address - Country:US
Practice Address - Phone:586-776-8877
Practice Address - Fax:586-776-3092
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064264207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4505183-10Medicaid
MIM018365OtherCHAMPUS
MIP30992FOtherBLUE CARE NETWORK
MI137417OtherCARE CHOICES
MI7614482OtherAETNA
MI0E01050OtherBCBS
MA3990056OtherCIGNA
MI137417OtherMERCY HEALTH PLANS
MIP00070142OtherRAILROAD MEDICARE
MA3990056OtherCIGNA
MI137417OtherCARE CHOICES
MI0M25330Medicare PIN