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Individual

MINA HAFZALAH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
3901 BEAUBIEN ST, DETROIT, MI 48201-2119
(313) 745-5629
(313) 966-0105
Mailing address
4201 ST. ANTOINE, UHC 5D - MAILBOX 226, DETROIT, MI 48201-2153
(313) 966-5051
(313) 966-0665

Taxonomy

Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
036.117289
IL
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
4301502539
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
036.117289
STATE LICENSE
IL
01
4301502539
STATE LICENSE
MI
01
7548
STATE LICENSE
SD
Enumeration date
10/21/2008
Last updated
08/14/2020
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