Provider Demographics
NPI:1063735058
Name:HASSAN AMIRIKIA MD PC
Entity type:Organization
Organization Name:HASSAN AMIRIKIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRIKIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-353-8910
Mailing Address - Street 1:29877 TELEGRAPH RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1332
Mailing Address - Country:US
Mailing Address - Phone:248-353-8910
Mailing Address - Fax:248-350-3519
Practice Address - Street 1:29877 TELEGRAPH RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1332
Practice Address - Country:US
Practice Address - Phone:248-353-8910
Practice Address - Fax:248-350-3519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031215207VE0102X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI181632110Medicaid
MI135880710Medicaid
MI135880710Medicaid
MI0824965Medicare PIN