Provider Demographics
NPI:1205024494
Name:M RAZI RAFEEQ MD INC
Entity Type:Organization
Organization Name:M RAZI RAFEEQ MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUEANN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GELACEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-693-2230
Mailing Address - Street 1:1050 ISAAC STREETS DR STE 128
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3243
Mailing Address - Country:US
Mailing Address - Phone:419-693-2230
Mailing Address - Fax:419-693-2602
Practice Address - Street 1:1050 ISAAC STREETS DR STE 128
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3243
Practice Address - Country:US
Practice Address - Phone:419-693-2230
Practice Address - Fax:419-693-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047541R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH206565077002OtherMEDICAL MUTUAL OF OHIO
MI4836490Medicaid
OH600655OtherBUCKEYE COMMUNITY HEALTH
OH000000137276OtherANTHEM
OH00088OtherPARAMOUNT HEALTH CARE
OH0493756Medicaid
OH000000137276OtherANTHEM
OH9343401Medicare PIN
OH00088OtherPARAMOUNT HEALTH CARE
OH9343403Medicare PIN