Provider Demographics
NPI:1750497483
Name:ISSA, RAAFAT (MD)
Entity Type:Individual
Prefix:
First Name:RAAFAT
Middle Name:
Last Name:ISSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29111 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1273
Mailing Address - Country:US
Mailing Address - Phone:586-566-1782
Mailing Address - Fax:586-566-1859
Practice Address - Street 1:29111 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1273
Practice Address - Country:US
Practice Address - Phone:586-566-1782
Practice Address - Fax:586-566-1859
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF94608Medicare UPIN
MIOM68180Medicare ID - Type Unspecified