Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4301502371 | MI |
Y | 207VE0102X | Reproductive Endocrinologist | 4301502371 | MI |
NPI | 1386094464 |
---|---|
Provider Name | Dr. Ali Bazzi |
First Address | Dearborn, MI 48126-2206 |
Second Address | Southfield, MI 48034-1753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2016 |
Last Update Date | 11/05/2020 |