Provider Demographics
NPI:1710904677
Name:METRO HEALTH CENTER, P.C.
Entity Type:Organization
Organization Name:METRO HEALTH CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAZZAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-292-1300
Mailing Address - Street 1:25406 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6200
Mailing Address - Country:US
Mailing Address - Phone:313-292-1300
Mailing Address - Fax:313-292-1305
Practice Address - Street 1:25406 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3926
Practice Address - Country:US
Practice Address - Phone:313-292-1300
Practice Address - Fax:313-292-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032279207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4473787Medicaid
MI4473787Medicaid
B43562Medicare UPIN