Provider Demographics
NPI:1336197706
Name:HAQUE, RAZA UL (MD)
Entity Type:Individual
Prefix:
First Name:RAZA
Middle Name:UL
Last Name:HAQUE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-351-8377
Mailing Address - Fax:517-351-1738
Practice Address - Street 1:2909 E GRAND RIVER AVE STE 102
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4335
Practice Address - Country:US
Practice Address - Phone:517-364-8670
Practice Address - Fax:517-364-8671
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-06-26
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Provider Licenses
StateLicense IDTaxonomies
MI4301061792207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1336197706Medicaid
MI104619863Medicaid
MI104619863Medicaid
MIG23591Medicare UPIN
MIG23591Medicare UPIN