Basic Information
| Provider Information | |||||||||
| NPI: | 1891188124 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAMZAVI PSYCHIATRY & WELLNESS CENTER PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43151 DALCOMA DR | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480386306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862868720 | ||||||||
| FaxNumber: | 5866496699 | ||||||||
| Practice Location | |||||||||
| Address1: | 74 W LONG LAKE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483042769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487317458 | ||||||||
| FaxNumber: | 2487317749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2015 | ||||||||
| LastUpdateDate: | 04/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | HAMZAVI | ||||||||
| AuthorizedOfficialFirstName: | ASRA | ||||||||
| AuthorizedOfficialMiddleName: | FATIMA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2487317458 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 5101015643 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.