Provider Demographics
NPI:1851842744
Name:NASERDEAN, HAMZI MOHAMAD (DC)
Entity Type:Individual
Prefix:DR
First Name:HAMZI
Middle Name:MOHAMAD
Last Name:NASERDEAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24350 JOY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1265
Mailing Address - Country:US
Mailing Address - Phone:313-924-1234
Mailing Address - Fax:313-924-1239
Practice Address - Street 1:24350 JOY RD STE 1
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1265
Practice Address - Country:US
Practice Address - Phone:313-924-1234
Practice Address - Fax:313-924-1239
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1851842744Medicaid