Provider Demographics
NPI:1376846162
Name:C BAZO GROUP, PLLC
Entity Type:Organization
Organization Name:C BAZO GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-987-7200
Mailing Address - Street 1:PO BOX 595466
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-5466
Mailing Address - Country:US
Mailing Address - Phone:810-987-7200
Mailing Address - Fax:810-987-5396
Practice Address - Street 1:1641 10TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5844
Practice Address - Country:US
Practice Address - Phone:810-987-7200
Practice Address - Fax:810-987-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty