Provider Demographics
NPI:1043221187
Name:YALDO, MAZIN K (MD)
Entity Type:Individual
Prefix:DR
First Name:MAZIN
Middle Name:K
Last Name:YALDO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:28501 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2951
Mailing Address - Country:US
Mailing Address - Phone:313-278-4540
Mailing Address - Fax:
Practice Address - Street 1:28501 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2951
Practice Address - Country:US
Practice Address - Phone:313-278-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051955207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F31960Medicare UPIN