Provider Demographics
NPI:1790714897
Name:GAZAYERLI, MOHAMED MOUNIR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:MOUNIR
Last Name:GAZAYERLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 W BIG BEAVER RD
Mailing Address - Street 2:BLDG, G
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3525
Mailing Address - Country:US
Mailing Address - Phone:248-643-4646
Mailing Address - Fax:248-614-0123
Practice Address - Street 1:1555 W BIG BEAVER RD
Practice Address - Street 2:BLDG, G
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3525
Practice Address - Country:US
Practice Address - Phone:248-643-4646
Practice Address - Fax:248-614-0123
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMG031263208600000X
MI4301031263208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106349341OtherBCBSM
MI1106349341OtherBCBSM
MIB44725Medicare UPIN