Provider Demographics
NPI:1932675667
Name:BIZZE, BAFEL
Entity Type:Individual
Prefix:
First Name:BAFEL
Middle Name:
Last Name:BIZZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36658 ARLENE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4309
Mailing Address - Country:US
Mailing Address - Phone:248-930-2420
Mailing Address - Fax:
Practice Address - Street 1:36658 ARLENE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4309
Practice Address - Country:US
Practice Address - Phone:248-930-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-20
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIN422877343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI801980873OtherTRANSPORTATION