Provider Demographics
NPI:1205874807
Name:RAZA, SALEEM (MD)
Entity type:Individual
Prefix:
First Name:SALEEM
Middle Name:
Last Name:RAZA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43800 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1136
Mailing Address - Country:US
Mailing Address - Phone:586-228-4635
Mailing Address - Fax:586-228-4520
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:SUITE 270
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:313-343-3481
Practice Address - Fax:313-343-7937
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301081516208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4881430Medicaid
03744331OtherECFMG
03744331OtherECFMG