Provider Demographics
NPI:1316106537
Name:BAZZI, WASSIM MOUSSA (MD)
Entity type:Individual
Prefix:DR
First Name:WASSIM
Middle Name:MOUSSA
Last Name:BAZZI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20952 E 12 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3200
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-6620
Practice Address - Street 1:18100 OAKWOOD BLVD STE 315
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4085
Practice Address - Country:US
Practice Address - Phone:313-271-0066
Practice Address - Fax:313-271-1047
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2018-01-25
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Provider Licenses
StateLicense IDTaxonomies
MI4301104287208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICB9133OtherMEDICARE RAILROAD
MI0E06273071Medicare PIN