Provider Demographics
NPI:1497781447
Name:BAZZI, MOHAMAD HASSAN (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:HASSAN
Last Name:BAZZI
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42680 FORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3338
Mailing Address - Country:US
Mailing Address - Phone:734-844-5700
Mailing Address - Fax:734-844-5703
Practice Address - Street 1:42680 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3338
Practice Address - Country:US
Practice Address - Phone:734-844-5700
Practice Address - Fax:734-844-5703
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066396208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2408212402OtherBCBS
MI4566509Medicaid
MI4566509Medicaid
MIH93734Medicare UPIN