Provider Demographics
NPI:1578752127
Name:DR. RAAFAT ISSA,MD,LLC
Entity Type:Organization
Organization Name:DR. RAAFAT ISSA,MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAAFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-566-1782
Mailing Address - Street 1:47100 SCHOENHERR RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4716
Mailing Address - Country:US
Mailing Address - Phone:586-566-1782
Mailing Address - Fax:586-566-1859
Practice Address - Street 1:47100 SCHOENHERR RD
Practice Address - Street 2:SUITE E
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-4716
Practice Address - Country:US
Practice Address - Phone:586-566-1782
Practice Address - Fax:586-566-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRI057892261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N87900Medicare PIN
MIF94608Medicare UPIN