MEDICARE: RABIH MOUSSA BAZZI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301077565	MI
2	207RN0300X	Nephrology Physician	4301077565	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1106358722	OTHER	MI	BLUE CROSS BLUE SHIELD
3	8041	OTHER		TOTAL HEALTH CARE
4	024084	OTHER		MIDWEST HEALTH PLAN
5	5315018532	OTHER	MI	CONTROLLED SUBSTANCE
6	146976	OTHER		GREAT LAKES HEALTH PLAN
7	05959549	OTHER		ECFMG
8	110H229590	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1235130691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RABIH MOUSSA BAZZI M.D.

Provider Business Mailing Address
First Line	:	1537 MONROE ST
Second Line	:	STE 100
City	:	DEARBORN
State	:	MI
Zip	:	48124-2842
Country	:	US
Telephone Number	:	313-359-2100
Fax Number	:	313-359-2104

Provider Business Practice Location Address
First Line	:	1537 MONROE ST
Second Line	:	STE 100
City	:	DEARBORN
State	:	MI
Zip	:	48124-2842
Country	:	US
Telephone Number	:	313-359-2100
Fax Number	:	313-359-2104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/07/2023

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