Provider Demographics
NPI:1104118397
Name:ELATRACHE, MAZEN (MD)
Entity type:Individual
Prefix:DR
First Name:MAZEN
Middle Name:
Last Name:ELATRACHE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19401 HUBBARD DR
Mailing Address - Street 2:HENRY FORD FAIRLANE MEDICAL CENTER
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126
Mailing Address - Country:US
Mailing Address - Phone:313-982-9307
Mailing Address - Fax:313-982-8320
Practice Address - Street 1:19401 HUBBARD DR
Practice Address - Street 2:HENRY FORD FAIRLANE MEDICAL CENTER
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-982-9307
Practice Address - Fax:313-982-8320
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2023-02-09
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Provider Licenses
StateLicense IDTaxonomies
MI4301098217207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine