Provider Demographics
NPI:1295780989
Name:HAMZAVI, FASAHAT HUSAIN (MD)
Entity type:Individual
Prefix:DR
First Name:FASAHAT
Middle Name:HUSAIN
Last Name:HAMZAVI
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 1:43151 DALCOMA DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6306
Mailing Address - Country:US
Mailing Address - Phone:586-286-8720
Mailing Address - Fax:586-286-8723
Practice Address - Street 1:43151 DALCOMA DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6306
Practice Address - Country:US
Practice Address - Phone:586-286-8720
Practice Address - Fax:586-286-8723
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFH078231207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICB4874OtherRAILROAD MEDICARE
MI4685466Medicaid
MI4685457Medicaid
MII18732Medicare UPIN
MI0P00670001Medicare PIN