Provider Demographics
NPI:1083779623
Name:RIFAI, ROUCHDI M (MD)
Entity type:Individual
Prefix:
First Name:ROUCHDI
Middle Name:M
Last Name:RIFAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:30603 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7729
Mailing Address - Country:US
Mailing Address - Phone:248-723-9370
Mailing Address - Fax:248-723-9687
Practice Address - Street 1:30603 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-7729
Practice Address - Country:US
Practice Address - Phone:248-723-9370
Practice Address - Fax:248-723-9687
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010476492086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301047649OtherLICENSE
MI0N50280Medicare PIN
MI4301047649OtherLICENSE