Provider Demographics
NPI:1407943962
Name:S L HUSAIN HAMZAVI MD PC
Entity Type:Organization
Organization Name:S L HUSAIN HAMZAVI MD PC
Other - Org Name:HAMZAVI DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUSAIN HAMZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-286-8720
Mailing Address - Street 1:43151 DALCOMA DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6306
Mailing Address - Country:US
Mailing Address - Phone:586-286-8720
Mailing Address - Fax:586-649-6699
Practice Address - Street 1:43151 DALCOMA DR
Practice Address - Street 2:SUITE 5
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6306
Practice Address - Country:US
Practice Address - Phone:586-286-8720
Practice Address - Fax:586-649-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICB4874OtherRAILROAD MEDICARE
MICB4874OtherRAILROAD MEDICARE