Provider Demographics
NPI:1992734214
Name:SAMIR-MOEZ, HAZEM (MD)
Entity type:Individual
Prefix:
First Name:HAZEM
Middle Name:
Last Name:SAMIR-MOEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAZEM
Other - Middle Name:
Other - Last Name:ABDELMOEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3301 HOLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3519
Mailing Address - Country:US
Mailing Address - Phone:313-872-5555
Mailing Address - Fax:313-216-2770
Practice Address - Street 1:3301 HOLBROOK ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3519
Practice Address - Country:US
Practice Address - Phone:313-872-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4636926Medicaid
MI4636926Medicaid
MIH36173Medicare UPIN