Provider Demographics
NPI:1235375361
Name:MEYSAMI, ALIREZA (MD)
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:MEYSAMI
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 1:39450 W 12 MILE RD
Mailing Address - Street 2:COLUMBUS MEDICAL CENTER, RHEUMATOLOGY DEPARTEMENT
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3600
Mailing Address - Country:US
Mailing Address - Phone:855-743-8643
Mailing Address - Fax:
Practice Address - Street 1:39450 W 12 MILE RD
Practice Address - Street 2:COLUMBUS MEDICAL CENTER, RHEUMATOLOGY DEPARTEMENT
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3600
Practice Address - Country:US
Practice Address - Phone:855-743-8643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232426207RR0500X, 207R00000X
MI4301099880207RR0500X
NH14999207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine