Healthcare Provider Details

I. General information

NPI: 1740499029
Provider Name (Legal Business Name): DANIEL SAUL MIZRAHI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 E JEFFERSON AVE STE 170
DETROIT MI
48214-3731
US

IV. Provider business mailing address

7633 E JEFFERSON AVE STE 170
DETROIT MI
48214-3731
US

V. Phone/Fax

Practice location:
  • Phone: 313-499-4661
  • Fax:
Mailing address:
  • Phone: 313-499-4661
  • Fax:

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:
Title or Position:
Credential:
Phone: