Provider Demographics
NPI:1336176486
Name:RAZA, SAYYID S (MD)
Entity Type:Individual
Prefix:
First Name:SAYYID
Middle Name:S
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 WEDGEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-3203
Mailing Address - Country:US
Mailing Address - Phone:989-891-0955
Mailing Address - Fax:989-891-0966
Practice Address - Street 1:2108 16TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7608
Practice Address - Country:US
Practice Address - Phone:989-891-0955
Practice Address - Fax:989-891-0966
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4291102Medicaid
MI0N31960Medicare PIN
MIG20972Medicare UPIN
MIP00083619Medicare PIN