Provider Demographics
NPI:1255304358
Name:ZAYZAFOON-MOSIER, SHAZA (MD)
Entity Type:Individual
Prefix:
First Name:SHAZA
Middle Name:
Last Name:ZAYZAFOON-MOSIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAZA
Other - Middle Name:
Other - Last Name:ZAYZAFOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-8481
Mailing Address - Fax:269-341-7781
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:BOX 74 BRONSON INTERNAL MEDICINE SPECIALIST
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-8481
Practice Address - Fax:269-341-7781
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068156208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4785990Medicaid
MICA2184OtherRAILROAD MEDICARE
MI1235131137 - BLHOtherBCBSM - BLH
MI1255304358Medicaid
MIH06012099 BLHMedicare PIN
MI0C97618104Medicare PIN
G97182Medicare UPIN