Provider Demographics
NPI:1811703002
Name:NASSER, MAZIN EDMOND
Entity type:Individual
Prefix:
First Name:MAZIN
Middle Name:EDMOND
Last Name:NASSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5616
Mailing Address - Country:US
Mailing Address - Phone:248-277-1071
Mailing Address - Fax:
Practice Address - Street 1:81 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5616
Practice Address - Country:US
Practice Address - Phone:248-277-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)