Healthcare Provider Details

I. General information

NPI: 1285617803
Provider Name (Legal Business Name): MAZEN ALAKHRAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 ST FRANCIS WAY STE 220
LAFAYETTE IN
47905-4922
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 765-428-5950
  • Fax: 765-428-5951
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number46921
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01054848A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: