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NPI Code Detail

MEDICARE: MEGAN MAZZELLA MD

MEDICARE: MEGAN MAZZELLA 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
12084P0800XPsychiatry Physician4301514007MI

General Provider Information

NPI Number : 1497363774
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN MAZZELLA MD
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD STE 3D
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18200 OAKWOOD BLVD
Second Line :
City : DEARBORN
State : MI
Zip : 48124-5025
Country : US
Telephone Number : 947-524-2760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2020
Last Update Date : 10/06/2025

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