Provider Demographics
NPI:1295375459
Name:ELITE VEIN AND HAIR RESTORATION CENTER PC
Entity Type:Organization
Organization Name:ELITE VEIN AND HAIR RESTORATION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NADA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-274-8346
Mailing Address - Street 1:2012 MONROE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2938
Mailing Address - Country:US
Mailing Address - Phone:313-274-8346
Mailing Address - Fax:313-274-7737
Practice Address - Street 1:2012 MONROE ST STE 102
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2938
Practice Address - Country:US
Practice Address - Phone:313-274-8346
Practice Address - Fax:313-274-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty