Provider Demographics
NPI:1801529516
Name:KHRAIZAT, MOHAMAD SAMIR (MBA-MHA, BS HCM)
Entity type:Individual
Prefix:MR
First Name:MOHAMAD
Middle Name:SAMIR
Last Name:KHRAIZAT
Suffix:
Gender:M
Credentials:MBA-MHA, BS HCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7334 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1310
Mailing Address - Country:US
Mailing Address - Phone:313-574-3887
Mailing Address - Fax:
Practice Address - Street 1:7334 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1310
Practice Address - Country:US
Practice Address - Phone:313-574-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator