Provider Demographics
NPI:1053468827
Name:WRAIKAT, RIAD MOH'D (PHD)
Entity Type:Individual
Prefix:DR
First Name:RIAD
Middle Name:MOH'D
Last Name:WRAIKAT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 ROSEMARY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3627
Mailing Address - Country:US
Mailing Address - Phone:313-581-6592
Mailing Address - Fax:
Practice Address - Street 1:16904 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3505
Practice Address - Country:US
Practice Address - Phone:313-581-7287
Practice Address - Fax:313-581-7318
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001626101YP2500X
MI6301013282103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid