MEDICARE: DETROIT MEDICAL CONSULTANTS 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	207R00000X	Internal Medicine Physician	5101016436	MI

General Provider Information

NPI Number	:	1609229848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DETROIT MEDICAL CONSULTANTS PC

Provider Business Mailing Address
First Line	:	4100 WOODWARD AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2173
Country	:	US
Telephone Number	:	313-974-6533
Fax Number	:	313-974-6713

Provider Business Practice Location Address
First Line	:	4100 WOODWARD AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2173
Country	:	US
Telephone Number	:	313-974-6533
Fax Number	:	313-974-6713

Authorized Official
Title or Position	:	OWNER
Name	:	HASSAN A. BAZZI
Credential	:	DO
Telephone Number	:	313-231-4716

Provider Enumeration Date	:	07/22/2016
Last Update Date	:	04/24/2018

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