Provider Demographics
NPI:1306990676
Name:M HAZEM RASLAN MD PC
Entity type:Organization
Organization Name:M HAZEM RASLAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:HAZEM
Authorized Official - Last Name:RASLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-641-3000
Mailing Address - Street 1:PO BOX 253044
Mailing Address - Street 2:
Mailing Address - City:W. BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-3044
Mailing Address - Country:US
Mailing Address - Phone:734-641-3000
Mailing Address - Fax:
Practice Address - Street 1:6300 N HAGGERTY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3568
Practice Address - Country:US
Practice Address - Phone:734-641-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMR057633207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4579131Medicaid
MIDB4794OtherMEDICARE RAILROAD
MIDB4794OtherMEDICARE RAILROAD
MI0N85480Medicare ID - Type Unspecified
MI=========OtherTAX ID