Provider Demographics
NPI:1235130691
Name:BAZZI, RABIH MOUSSA (MD)
Entity Type:Individual
Prefix:
First Name:RABIH
Middle Name:MOUSSA
Last Name:BAZZI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1537 MONROE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2842
Mailing Address - Country:US
Mailing Address - Phone:313-359-2100
Mailing Address - Fax:313-359-2104
Practice Address - Street 1:1537 MONROE ST
Practice Address - Street 2:STE 100
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2842
Practice Address - Country:US
Practice Address - Phone:313-359-2100
Practice Address - Fax:313-359-2104
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301077565207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104955561Medicaid
MI1106358722OtherBLUE CROSS BLUE SHIELD
8041OtherTOTAL HEALTH CARE
024084OtherMIDWEST HEALTH PLAN
MI5315018532OtherCONTROLLED SUBSTANCE
146976OtherGREAT LAKES HEALTH PLAN
05959549OtherECFMG
MI110H229590OtherBLUE CROSS BLUE SHIELD
MI110H229590OtherBLUE CROSS BLUE SHIELD
024084OtherMIDWEST HEALTH PLAN
8041OtherTOTAL HEALTH CARE
146976OtherGREAT LAKES HEALTH PLAN