Provider Demographics
NPI:1639730963
Name:AMIR, RAWAN A
Entity Type:Individual
Prefix:
First Name:RAWAN
Middle Name:A
Last Name:AMIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3279 SCHUST RD APT 205
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-8104
Mailing Address - Country:US
Mailing Address - Phone:989-928-5536
Mailing Address - Fax:
Practice Address - Street 1:3279 SCHUST RD APT 205
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-8104
Practice Address - Country:US
Practice Address - Phone:989-928-5536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351045307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine