Provider Demographics
NPI:1053325043
Name:AMIRIKIA, HASSAN (MD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:AMIRIKIA
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 1:4727 ST ANTOINE
Mailing Address - Street 2:STE 408
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1461
Mailing Address - Country:US
Mailing Address - Phone:313-832-0766
Mailing Address - Fax:313-832-0627
Practice Address - Street 1:4727 ST ANTOINE
Practice Address - Street 2:STE 408
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1461
Practice Address - Country:US
Practice Address - Phone:313-832-0766
Practice Address - Fax:313-832-0627
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031215207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0824965OtherBCBS
B46838Medicare UPIN
08249658Medicare ID - Type Unspecified