MEDICARE: CASS RIVER HEALTH PLAZA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301059644	MI

General Provider Information

NPI Number	:	1356600431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASS RIVER HEALTH PLAZA PLLC

Provider Business Mailing Address
First Line	:	6940 DIXIE HWY
Second Line	:
City	:	BRIDGEPORT
State	:	MI
Zip	:	48722-9760
Country	:	US
Telephone Number	:	989-746-0933
Fax Number	:	989-746-5070

Provider Business Practice Location Address
First Line	:	6940 DIXIE HWY
Second Line	:
City	:	BRIDGEPORT
State	:	MI
Zip	:	48722-9760
Country	:	US
Telephone Number	:	989-746-0933
Fax Number	:	989-746-5070

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NAVEED MAHFOOZ
Credential	:	M.D.
Telephone Number	:	989-746-0933

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	05/10/2012

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