Provider Demographics
NPI:1699012450
Name:HUSSEIN MAZLOUM MD PC
Entity type:Organization
Organization Name:HUSSEIN MAZLOUM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:MAZLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-239-8051
Mailing Address - Street 1:1020 CHARTER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3584
Mailing Address - Country:US
Mailing Address - Phone:810-239-8051
Mailing Address - Fax:810-239-3925
Practice Address - Street 1:1020 CHARTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3584
Practice Address - Country:US
Practice Address - Phone:810-239-8051
Practice Address - Fax:810-239-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHM063987208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4356904Medicaid
MI4356904Medicaid