MEDICARE: NICK BAZZY

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	332B00000X	Durable Medical Equipment & Medical Supplies	2841972	MI

General Provider Information

NPI Number	:	1902295066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICK BAZZY

Provider Business Mailing Address
First Line	:	5302 ROYAL VALE LN
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-4211
Country	:	US
Telephone Number	:	248-885-7535
Fax Number	:

Provider Business Practice Location Address
First Line	:	5302 ROYAL VALE LN
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-4211
Country	:	US
Telephone Number	:	248-885-7535
Fax Number	:

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

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	01/13/2015

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Directions to “ NICK BAZZY ” Practice Location

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