Provider Demographics
NPI:1922738418
Name:BAZZI, SAMIRA
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:
Last Name:BAZZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMIRA
Other - Middle Name:
Other - Last Name:BAZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BILLER
Mailing Address - Street 1:7846 WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-5210
Mailing Address - Country:US
Mailing Address - Phone:313-443-0523
Mailing Address - Fax:
Practice Address - Street 1:7846 WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-5210
Practice Address - Country:US
Practice Address - Phone:313-443-0523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor