MEDICARE: KAZAK GROUP LLC

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1689057739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAZAK GROUP LLC

Provider Business Mailing Address
First Line	:	4688 QUARTON RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-2541
Country	:	US
Telephone Number	:	248-930-9572
Fax Number	:

Provider Business Practice Location Address
First Line	:	4688 QUARTON RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-2541
Country	:	US
Telephone Number	:	248-930-9572
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	HUDA KAZAK
Credential	:
Telephone Number	:	248-930-9572

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	07/08/2015

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Directions to “KAZAK GROUP LLC ” Practice Location

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