MEDICARE: MIGHTY MASON OUTREACH MINISTRY CHURCH

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1245563626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIGHTY MASON OUTREACH MINISTRY CHURCH

Provider Business Mailing Address
First Line	:	4722 JOHN R RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-3555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1799 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-3145
Country	:	US
Telephone Number	:	586-222-1900
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. MUZAFFER AL ZAND
Credential	:
Telephone Number	:	586-222-1900

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	09/16/2009

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Directions to “MIGHTY MASON OUTREACH MINISTRY CHURCH ” Practice Location

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