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General NPI Number Information
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NPI Number | 1699283283
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Entity Type | Organization
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Legal Business Name | PROVIDERS TEK INC.
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 4700 GREENFIELD RD # 2E
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City | DEARBORN
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State | MI
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Zip | 48126-4124
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Country | US
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Telephone | 734-462-0340
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1997
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City | DEARBORN
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State | MI
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Zip | 48121-1997
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Country | US
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Telephone | 313-740-1111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOUSSA BAZZI
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Credential | MD
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Telephone | 313-740-1111
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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 | 4301105966
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License Number State | MI
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Taxonomy #2
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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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