MEDICARE: DR. BASSAM M MAAZ MD

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	2084N0400X	Neurology Physician	4301053885	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1308248992	OTHER	MI	BCBS OF MICHIGAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851314314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASSAM M MAAZ MD

Provider Business Mailing Address
First Line	:	23522 MICHIGAN AVE
Second Line	:	STE 200
City	:	DEARBORN
State	:	MI
Zip	:	48124-1934
Country	:	US
Telephone Number	:	313-724-0584
Fax Number	:	313-724-0593

Provider Business Practice Location Address
First Line	:	23522 MICHIGAN AVE
Second Line	:	STE 200
City	:	DEARBORN
State	:	MI
Zip	:	48124-1934
Country	:	US
Telephone Number	:	313-724-0584
Fax Number	:	313-724-0593

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	10/20/2014

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