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General NPI Number Information
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NPI Number | 1073564662
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Entity Type | Organization
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Legal Business Name | MAZEN SABBAQ M.D. P.C.
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 75 BARCLAY CIR STE 205
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-5821
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Country | US
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Telephone | 248-651-6430
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Fax | 248-650-1382
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Provider Business Mailing Address
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Address Line | 75 BARCLAY CIR STE 205
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-5821
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Country | US
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Telephone | 248-651-6430
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Fax | 248-650-1382
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAZEN SABBAQ
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Credential | M.D.
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Telephone | 248-651-6430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4301075366
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License Number State | MI
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