Healthcare Provider Details

I. General information

NPI: 1245563626
Provider Name (Legal Business Name): MIGHTY MASON OUTREACH MINISTRY CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 E GRAND BLVD
DETROIT MI
48211-3145
US

IV. Provider business mailing address

4722 JOHN R RD
TROY MI
48085-3555
US

V. Phone/Fax

Practice location:
  • Phone: 586-222-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MUZAFFER AL ZAND
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 586-222-1900