Provider Demographics
NPI:1831176189
Name:RAZA, SHAZIA (MD)
Entity type:Individual
Prefix:DR
First Name:SHAZIA
Middle Name:
Last Name:RAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAZIA
Other - Middle Name:
Other - Last Name:SHAMIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4020 VENOY RD STE 700
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1891
Mailing Address - Country:US
Mailing Address - Phone:734-454-8001
Mailing Address - Fax:
Practice Address - Street 1:4020 VENOY RD STE 700
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1891
Practice Address - Country:US
Practice Address - Phone:734-454-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091041207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1033514OtherMCLAREN HEALTH ADVANTAGE
MI1103313911OtherBLUE CROSS BLUE SHIELD
MI200000016236OtherPHP
MI200000016236OtherPHP-FAMILYCARE
KY64071087Medicaid
MI1033514OtherMCLAREN HEALTH PLAN-MEDICAID
MIP00473883OtherRAILROAD MEDICARE
MI1033514OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI1103313911OtherBLUE CARE NETWORK
MI1103313911OtherBLUE CARE NETWORK
MI200000016236OtherPHP
KYH94756Medicare UPIN