Provider Demographics
NPI:1083605877
Name:HAKIMZADEH, ROXANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:
Last Name:HAKIMZADEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BARCLAY CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5820
Mailing Address - Country:US
Mailing Address - Phone:248-856-6500
Mailing Address - Fax:248-856-6504
Practice Address - Street 1:75 BARCLAY CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5820
Practice Address - Country:US
Practice Address - Phone:248-856-6500
Practice Address - Fax:248-856-6504
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064286207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3378961Medicaid
F59096Medicare UPIN
MI3378961Medicaid