Individual
HESHAM M BAZARAA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
761 45TH ST STE 110, MUNSTER, IN 46321-2899
(219) 922-3020
(219) 922-3023
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
01054298A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200340980
—
IN
05
—
200340980A
—
IN
Enumeration date
09/19/2005
Last updated
02/23/2023
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