Provider Demographics
NPI:1194364984
Name:HAZIMEH PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:HAZIMEH PRIMARY CARE PLLC
Other - Org Name:HAZIMEH PRIMARY CARE PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZIMEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-415-1515
Mailing Address - Street 1:7534 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1690
Mailing Address - Country:US
Mailing Address - Phone:313-455-9765
Mailing Address - Fax:
Practice Address - Street 1:7534 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1690
Practice Address - Country:US
Practice Address - Phone:313-455-9765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty