MEDICARE: DEVIN BAZICK MD

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	390200000X	Student in an Organized Health Care Education/Training Program		SC

General Provider Information

NPI Number	:	1477058626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVIN BAZICK MD

Provider Business Mailing Address
First Line	:	GRAND STAND PEDIATRICS
Second Line	:	8120 ROURK STREET
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4607
Country	:	US
Telephone Number	:	843-449-1438
Fax Number	:

Provider Business Practice Location Address
First Line	:	GRAND STRAND PEDIATRICS
Second Line	:	5015 CAROLINA FOREST BLVD
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579
Country	:	US
Telephone Number	:	843-945-1740
Fax Number	:	843-286-1349

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

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	01/31/2024

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