Provider Demographics
NPI:1275825770
Name:MAZEN HAMAMEH DO PC
Entity Type:Organization
Organization Name:MAZEN HAMAMEH DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:HAMAMEH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-839-6610
Mailing Address - Street 1:5831 WHITEFIELD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127
Mailing Address - Country:US
Mailing Address - Phone:734-839-6610
Mailing Address - Fax:734-839-6611
Practice Address - Street 1:5831 WHITEFIELD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127
Practice Address - Country:US
Practice Address - Phone:734-839-6610
Practice Address - Fax:734-839-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010167952080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1215142153OtherBLUE CARE NETWORK
MI1215142153Medicaid
MI1215142153OtherCOMMERICAL
MI1215142153OtherBLUE CROSS BLUE SHIELD OF MICHIGAN