Individual
DAVID MAZUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1055 MEDICAL PARK DR SE, GRAND RAPIDS, MI 49546-3671
(800) 968-6866
Mailing address
PO BOX 1969, GRAND RAPIDS, MI 49501-1969
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
5101009144
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3361580
—
MI
01
—
DM009144
BLUE CROSS BLUE SHIELD
—
Enumeration date
09/19/2005
Last updated
09/13/2010
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