Provider Demographics
NPI:1265747463
Name:HAZIN, RIBHI (MD)
Entity type:Individual
Prefix:
First Name:RIBHI
Middle Name:
Last Name:HAZIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-0393
Mailing Address - Country:US
Mailing Address - Phone:734-699-2900
Mailing Address - Fax:313-731-0213
Practice Address - Street 1:3611 CARPENTER ST STE 5
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-2784
Practice Address - Country:US
Practice Address - Phone:313-733-8286
Practice Address - Fax:313-826-0899
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301097437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1265747463Medicaid
MIMI90730001Medicare PIN