Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301063987 | MI |
Y | 208600000X | Surgeon | 4301063987 | MI |
N | 2086S0127X | Trauma Surgeon | 4301063987 | MI |
NPI | 1356368781 |
---|---|
Provider Name | Dr. Hussein Ali Mazloum |
First Address | Grand Blanc, MI 48439-1973 |
Second Address | Flint, MI 48532-3584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 22/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0202505992 | BCBS (01) | MI |
104356904 | (05) | MI |
H53024 | (02) | MI |