Provider Demographics
NPI:1841532454
Name:M MOUNIR GAZAYERLI MD PC
Entity type:Organization
Organization Name:M MOUNIR GAZAYERLI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:MOUNIR
Authorized Official - Last Name:GAZAYERLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-643-4646
Mailing Address - Street 1:1555 W BIG BEAVER RD
Mailing Address - Street 2:BUILDING G
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3525
Mailing Address - Country:US
Mailing Address - Phone:248-643-4646
Mailing Address - Fax:248-643-8745
Practice Address - Street 1:1555 W BIG BEAVER RD
Practice Address - Street 2:BUILDING G
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3525
Practice Address - Country:US
Practice Address - Phone:248-643-4646
Practice Address - Fax:248-643-8745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031263208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty