Provider Demographics
NPI:1144838335
Name:CHAMSEDDIN, RANIM
Entity type:Individual
Prefix:
First Name:RANIM
Middle Name:
Last Name:CHAMSEDDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 FIVE POINTS DR UNIT 110
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2372
Mailing Address - Country:US
Mailing Address - Phone:248-229-2809
Mailing Address - Fax:
Practice Address - Street 1:3200 FIVE POINTS DR UNIT 110
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2372
Practice Address - Country:US
Practice Address - Phone:248-229-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351046617APP20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine