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General NPI Number Information
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NPI Number | 1083866107
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Entity Type | Individual
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Provider Name | MINA HAFZALAH M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 3901 BEAUBIEN ST
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City | DETROIT
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State | MI
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Zip | 48201-2119
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Country | US
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Telephone | 313-745-5629
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Fax | 313-966-0105
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Provider Business Mailing Address
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Address Line | 4201 ST. ANTOINE UHC 5D - MAILBOX 226
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-966-5051
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Fax | 313-966-0665
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 036.117289
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 4301502539
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License Number State | MI
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