Provider Demographics
NPI:1366035990
Name:MAZLOUM, ABBAS
Entity Type:Individual
Prefix:
First Name:ABBAS
Middle Name:
Last Name:MAZLOUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3515
Mailing Address - Country:US
Mailing Address - Phone:313-424-4448
Mailing Address - Fax:313-402-4302
Practice Address - Street 1:2430 HANNAN RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2009
Practice Address - Country:US
Practice Address - Phone:313-424-4448
Practice Address - Fax:313-402-4302
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies