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General NPI Number Information
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NPI Number | 1447827894
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Entity Type | Organization
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Legal Business Name | RIVERVIEW NEUROMUSCULAR PAIN CENTER PLLC
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 7633 E JEFFERSON AVE STE 170
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City | DETROIT
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State | MI
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Zip | 48214-3731
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Country | US
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Telephone | 313-740-1111
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Fax | 313-672-6241
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Provider Business Mailing Address
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Address Line | 7633 E JEFFERSON AVE STE 170
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City | DETROIT
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State | MI
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Zip | 48214-3731
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Country | US
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Telephone | 313-740-1111
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Fax | 313-672-6241
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOUSSA BAZZI
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Credential | MD
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Telephone | 313-241-2491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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