Provider Demographics
NPI:1609229848
Name:DETROIT MEDICAL CONSULTANTS PC
Entity Type:Organization
Organization Name:DETROIT MEDICAL CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-231-4716
Mailing Address - Street 1:4100 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2173
Mailing Address - Country:US
Mailing Address - Phone:313-974-6533
Mailing Address - Fax:313-974-6713
Practice Address - Street 1:4100 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2173
Practice Address - Country:US
Practice Address - Phone:313-974-6533
Practice Address - Fax:313-974-6713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty