Provider Demographics
NPI:1356470355
Name:S. TALIB RAZA, P.C.
Entity Type:Organization
Organization Name:S. TALIB RAZA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:M TALIB
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-489-1759
Mailing Address - Street 1:29495 PARKSIDE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2668
Mailing Address - Country:US
Mailing Address - Phone:248-489-1759
Mailing Address - Fax:734-283-5555
Practice Address - Street 1:18025 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7432
Practice Address - Country:US
Practice Address - Phone:734-283-5555
Practice Address - Fax:734-283-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088026207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H27304OtherBLUE CROSS
MI1235106915Medicaid
MI0H27304OtherBLUE CROSS
MI1235106915Medicaid