Healthcare Provider Details

I. General information

NPI: 1194178046
Provider Name (Legal Business Name): IBRAHIM BAIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6224 HORGER ST
DEARBORN MI
48126-2227
US

IV. Provider business mailing address

6224 HORGER ST
DEARBORN MI
48126-2227
US

V. Phone/Fax

Practice location:
  • Phone: 313-722-5009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: