Provider Demographics
NPI:1124172234
Name:ABDUL T RAZACK M D INC
Entity type:Organization
Organization Name:ABDUL T RAZACK M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-960-2718
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-0364
Mailing Address - Country:US
Mailing Address - Phone:440-960-2718
Mailing Address - Fax:440-960-5633
Practice Address - Street 1:3600 KOLBE RD
Practice Address - Street 2:SUITE 221
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1654
Practice Address - Country:US
Practice Address - Phone:440-960-2718
Practice Address - Fax:440-960-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH64185207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty