Basic Information
| Provider Information | |||||||||
| NPI: | 1477553063 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAZZI | ||||||||
| FirstName: | ALI | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 BISCAYNE BLVD | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331379800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055710620 | ||||||||
| FaxNumber: | 3055768099 | ||||||||
| Practice Location | |||||||||
| Address1: | 21097 NE 27TH COURT | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331801900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057920012 | ||||||||
| FaxNumber: | 3057920030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 04/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME52962 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 061948500 | 05 | FL | MEDICAID |