Basic Information
| Provider Information | |||||||||
| NPI: | 1831176189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAZA | ||||||||
| FirstName: | SHAZIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHAMIM | ||||||||
| OtherFirstName: | SHAZIA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4020 VENOY RD STE 700 | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481841891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344548001 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4020 VENOY RD STE 700 | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481841891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344548001 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 06/23/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 4301091041 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1033514 | 01 | MI | MCLAREN HEALTH ADVANTAGE | OTHER | 1103313911 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 200000016236 | 01 | MI | PHP | OTHER | 200000016236 | 01 | MI | PHP-FAMILYCARE | OTHER | 64071087 | 05 | KY | MEDICAID | 1033514 | 01 | MI | MCLAREN HEALTH PLAN-MEDICAID | OTHER | P00473883 | 01 | MI | RAILROAD MEDICARE | OTHER | 1033514 | 01 | MI | MCLAREN HEALTH PLAN-COMMERCIAL | OTHER | 1103313911 | 01 | MI | BLUE CARE NETWORK | OTHER |