MEDICARE: MAZIN PUTRUS YONAN 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	207R00000X	Internal Medicine Physician	MY075033	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801888904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAZIN PUTRUS YONAN MD

Provider Business Mailing Address
First Line	:	2221 LIVERNOIS RD
Second Line	:	100
City	:	TROY
State	:	MI
Zip	:	48083-1603
Country	:	US
Telephone Number	:	248-250-9474
Fax Number	:	248-250-9483

Provider Business Practice Location Address
First Line	:	2221 LIVERNOIS RD
Second Line	:	100
City	:	TROY
State	:	MI
Zip	:	48083-1603
Country	:	US
Telephone Number	:	248-250-9474
Fax Number	:	248-250-9483

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	10/27/2011

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