Provider Demographics
NPI:1467517862
Name:HAMTRAMCK MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:HAMTRAMCK MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAZEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMIR-MOEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-410-2010
Mailing Address - Street 1:27141 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1669
Mailing Address - Country:US
Mailing Address - Phone:313-410-2010
Mailing Address - Fax:313-561-6666
Practice Address - Street 1:9222 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3731
Practice Address - Country:US
Practice Address - Phone:313-872-5555
Practice Address - Fax:313-872-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4636926Medicaid
MI4636926Medicaid