MEDICARE: DR. MARIO NJEIM 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	5315031441	MI

General Provider Information

NPI Number	:	1326233826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO NJEIM M.D

Provider Business Mailing Address
First Line	:	1350 W BETHUNE ST
Second Line	:	APP 910
City	:	DETROIT
State	:	MI
Zip	:	48202-2600
Country	:	US
Telephone Number	:	313-529-5664
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 W BETHUNE ST
Second Line	:	APP 910
City	:	DETROIT
State	:	MI
Zip	:	48202-2600
Country	:	US
Telephone Number	:	313-529-5664
Fax Number	:

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

Provider Enumeration Date	:	09/08/2007
Last Update Date	:	09/08/2007

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