Provider Demographics
NPI:1124553011
Name:BAIZ, HASSAN ISSA (MD)
Entity type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:ISSA
Last Name:BAIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5479 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3222
Mailing Address - Country:US
Mailing Address - Phone:313-791-7992
Mailing Address - Fax:313-406-2961
Practice Address - Street 1:5479 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3222
Practice Address - Country:US
Practice Address - Phone:313-791-7992
Practice Address - Fax:313-406-2961
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301502441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty