Provider Demographics
NPI:1376616615
Name:AFRAM, MAZEN SAMI (MD)
Entity Type:Individual
Prefix:
First Name:MAZEN
Middle Name:SAMI
Last Name:AFRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 W UNIVERSITY DR
Mailing Address - Street 2:STE 175
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1893
Mailing Address - Country:US
Mailing Address - Phone:248-650-4738
Mailing Address - Fax:248-650-4976
Practice Address - Street 1:1135 W UNIVERSITY DR
Practice Address - Street 2:STE 175
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1893
Practice Address - Country:US
Practice Address - Phone:248-650-4738
Practice Address - Fax:248-650-4976
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMA072402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106342451OtherBCBSM
MION56310Medicare ID - Type Unspecified