Healthcare Provider Details

I. General information

NPI: 1023522414
Provider Name (Legal Business Name): MIZRAHI MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 E JEFFERSON AVE STE 250
DETROIT MI
48214-3731
US

IV. Provider business mailing address

7633 E JEFFERSON AVE STE 250
DETROIT MI
48214-3731
US

V. Phone/Fax

Practice location:
  • Phone: 313-821-3338
  • Fax: 313-823-5363
Mailing address:
  • Phone: 313-821-3338
  • Fax: 313-823-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101016034
License Number StateMI

VIII. Authorized Official

Name: DANIEL S MIZRAHI
Title or Position: OWNER
Credential: DO
Phone: 248-890-3994