Provider Demographics
NPI:1356781256
Name:AL MUSHREF, MAZEN (MD)
Entity type:Individual
Prefix:
First Name:MAZEN
Middle Name:
Last Name:AL MUSHREF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:38 COMMERCE AVE SW APT 407
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4143
Mailing Address - Country:US
Mailing Address - Phone:706-254-1512
Mailing Address - Fax:
Practice Address - Street 1:19251 MACK AVE STE 333
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2898
Practice Address - Country:US
Practice Address - Phone:313-343-7280
Practice Address - Fax:313-343-7921
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301114419207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism