Provider Demographics
NPI:1740499029
Name:MIZRAHI, DANIEL SAUL (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SAUL
Last Name:MIZRAHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7633 E JEFFERSON AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3731
Mailing Address - Country:US
Mailing Address - Phone:313-499-4661
Mailing Address - Fax:
Practice Address - Street 1:7633 E JEFFERSON AVE STE 170
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3731
Practice Address - Country:US
Practice Address - Phone:313-499-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016034207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI518837611Medicaid