Provider Demographics
NPI:1144294406
Name:RAZACK, ABDUL T (MD)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:T
Last Name:RAZACK
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:P.O. BOX 364
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-0364
Mailing Address - Country:US
Mailing Address - Phone:440-960-2718
Mailing Address - Fax:440-960-5633
Practice Address - Street 1:3600 KOLBE RD
Practice Address - Street 2:SUITE 221
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1652
Practice Address - Country:US
Practice Address - Phone:440-960-2718
Practice Address - Fax:440-960-5633
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH64185174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0894368Medicaid
OH0894368Medicaid
0728021Medicare PIN