MEDICARE: MAZEN HAMAMEH DO PC

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	2080A0000X	Pediatric Adolescent Medicine Physician	5101016795	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1215142153	OTHER	MI	BLUE CARE NETWORK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1215142153	OTHER	MI	COMMERICAL
4	1215142153	OTHER	MI	BLUE CROSS BLUE SHIELD OF MICHIGAN

General Provider Information

NPI Number	:	1275825770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAZEN HAMAMEH DO PC

Provider Business Mailing Address
First Line	:	5831 WHITEFIELD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127
Country	:	US
Telephone Number	:	734-839-6610
Fax Number	:	734-839-6611

Provider Business Practice Location Address
First Line	:	5831 WHITEFIELD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127
Country	:	US
Telephone Number	:	734-839-6610
Fax Number	:	734-839-6611

Authorized Official
Title or Position	:	MEDICAL PROVIDER
Name	:	DR. MAZEN N HAMAMEH
Credential	:	DO
Telephone Number	:	734-839-6610

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	05/03/2011

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