Provider Demographics
NPI:1356368781
Name:MAZLOUM, HUSSEIN ALI (MD)
Entity type:Individual
Prefix:DR
First Name:HUSSEIN
Middle Name:ALI
Last Name:MAZLOUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8382 HOLLY RD
Mailing Address - Street 2:STE 2
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1973
Mailing Address - Country:US
Mailing Address - Phone:810-720-0368
Mailing Address - Fax:810-720-0371
Practice Address - Street 1:1020 CHARTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3584
Practice Address - Country:US
Practice Address - Phone:810-720-0368
Practice Address - Fax:810-720-0371
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301063987208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0202505992OtherBCBS
MI104356904Medicaid
MIH53024Medicare UPIN
MI0202505992OtherBCBS