Provider Demographics
NPI:1629753223
Name:BAZZI, FATIMA (DNP)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:BAZZI
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25850 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4110
Mailing Address - Country:US
Mailing Address - Phone:313-231-3152
Mailing Address - Fax:
Practice Address - Street 1:6500 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1813
Practice Address - Country:US
Practice Address - Phone:313-584-7900
Practice Address - Fax:313-584-4411
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704330590363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner