Basic Information
| Provider Information | |||||||||
| NPI: | 1760640940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAIS | ||||||||
| FirstName: | MUHAMMAD | ||||||||
| MiddleName: | SALMAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAIS | ||||||||
| OtherFirstName: | MUHAMMAD | ||||||||
| OtherMiddleName: | SALMAN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13811 MYRTLE DR | ||||||||
| Address2: | |||||||||
| City: | DEWITT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488208509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894002889 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13811 MYRTLE DR | ||||||||
| Address2: | |||||||||
| City: | DEWITT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488208509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894002889 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2008 | ||||||||
| LastUpdateDate: | 12/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301093016 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 4301093016 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.