Provider Demographics
NPI:1699283283
Name:PROVIDERS TEK INC.
Entity type:Organization
Organization Name:PROVIDERS TEK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOUSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-740-1111
Mailing Address - Street 1:PO BOX 1997
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-1997
Mailing Address - Country:US
Mailing Address - Phone:313-740-1111
Mailing Address - Fax:
Practice Address - Street 1:4700 GREENFIELD RD # 2E
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4124
Practice Address - Country:US
Practice Address - Phone:734-462-0340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301105966208100000X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty