Healthcare Provider Details

I. General information

NPI: 1740067313
Provider Name (Legal Business Name): NADIA MAZRAANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26650 EUREKA RD
TAYLOR MI
48180-4835
US

IV. Provider business mailing address

17409 ROLLING WOODS CIR
NORTHVILLE MI
48168-1895
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301061317
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: