Provider Demographics
NPI:1083456396
Name:IZRAIQI, ABDELRAHMAN (MD)
Entity type:Individual
Prefix:
First Name:ABDELRAHMAN
Middle Name:
Last Name:IZRAIQI
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:COREWELL HEALTH WILLIAM BEAUMONT UNIVERSITY HOSPITAL
Mailing Address - Street 2:3535 W 13 MILE RD
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-551-3000
Mailing Address - Fax:248-551-2032
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-551-3000
Practice Address - Fax:248-551-3000
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2025-06-20
Deactivation Date:2025-01-16
Deactivation Code:
Reactivation Date:2025-06-20
Provider Licenses
StateLicense IDTaxonomies
MI4351052401390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program