Provider Demographics
NPI:1609031202
Name:BAZGER, NICKOLE (DO)
Entity Type:Individual
Prefix:DR
First Name:NICKOLE
Middle Name:
Last Name:BAZGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18080 MACK AVENUE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230
Mailing Address - Country:US
Mailing Address - Phone:313-499-8368
Mailing Address - Fax:313-789-1810
Practice Address - Street 1:18080 MACK AVENUE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230
Practice Address - Country:US
Practice Address - Phone:313-499-8368
Practice Address - Fax:313-789-1810
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020175207VE0102X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1609031202Medicaid
MI1609031202Medicaid
IN000000726928OtherBCBS