Provider Demographics
NPI:1245446046
Name:MAZEI, CATHERINE (DO)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MAZEI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-1317
Mailing Address - Country:US
Mailing Address - Phone:269-427-7967
Mailing Address - Fax:269-427-7574
Practice Address - Street 1:308 CHARLES ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013-1317
Practice Address - Country:US
Practice Address - Phone:269-427-7967
Practice Address - Fax:269-427-7574
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00416397OtherRR MEDICARE
MI700B510850OtherBCBS OF MI
MI700B510850OtherBCBS OF MI