Organization
DERMATOLOGY SPECIALISTS OF CANTON, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ILTEFAT H. HAMZAVI M.D. (PRESIDENT)
(734) 495-1506
Entity
Organization
Contact information
Practice address
285 N LILLEY RD, CANTON, MI 48187-3907
(734) 495-1506
(734) 495-1780
Mailing address
43151 DALCOMA DRIVE, SUITE 6, CLINTON TOWNSHIP, MI 48038
(586) 286-8720
(866) 790-6803
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301067985
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO8072
RAILROAD MEDICARE
MI
Enumeration date
11/04/2008
Last updated
03/15/2011
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