Provider Demographics
NPI:1386200731
Name:LATEEF, HAMZAH (MD)
Entity Type:Individual
Prefix:
First Name:HAMZAH
Middle Name:
Last Name:LATEEF
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 1:4000 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670-5605
Mailing Address - Country:US
Mailing Address - Phone:844-832-1956
Mailing Address - Fax:989-633-5241
Practice Address - Street 1:4000 WELLNESS DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48670-1284
Practice Address - Country:US
Practice Address - Phone:989-839-1644
Practice Address - Fax:989-839-3029
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301506425207R00000X
MI4351047005390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine