Individual
MAZEN EL-KOUDSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
12940 W WARREN AVE, DEARBORN, MI 48126-1535
(313) 945-8210
(313) 945-0729
Mailing address
1405 HOLLYWOOD ST, DEARBORN, MI 48124-5021
(313) 523-0681
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
4704343520
MI
363LG0600X
Gerontology Nurse Practitioner
4704343520
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704343520
MI
Other
Enumeration date
02/02/2021
Last updated
05/11/2021
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