Provider Demographics
NPI:1992785638
Name:MIKHAIL, RAOUF AZIZ (MD)
Entity type:Individual
Prefix:MR
First Name:RAOUF
Middle Name:AZIZ
Last Name:MIKHAIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G1075 N BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4431
Mailing Address - Country:US
Mailing Address - Phone:810-238-1118
Mailing Address - Fax:810-238-9849
Practice Address - Street 1:G1075 N BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4431
Practice Address - Country:US
Practice Address - Phone:810-238-1118
Practice Address - Fax:810-238-9849
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRM039160208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1480474Medicaid
MI2512631OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
0202111OtherHEALTH PLUS
MI0250211Medicare ID - Type Unspecified
0202111OtherHEALTH PLUS