Provider Demographics
NPI:1801989553
Name:MOHAMAD BAZZI M D P C
Entity type:Organization
Organization Name:MOHAMAD BAZZI M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:BAZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-844-5700
Mailing Address - Street 1:42680 FORD RD.
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187
Mailing Address - Country:US
Mailing Address - Phone:734-844-5700
Mailing Address - Fax:734-844-5703
Practice Address - Street 1:42680 FORD RD.
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187
Practice Address - Country:US
Practice Address - Phone:734-844-5700
Practice Address - Fax:734-844-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066396208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI16435OtherMCARE
MI7175546OtherAETNA
MI138185OtherCARE CHOICES
MI2408212402OtherBLUE CROSS BLUE SHIELD
MI4566509Medicaid
MIH93734Medicare UPIN
MI0N77750Medicare PIN