Individual
WISAM ALQAZZAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
PO BOX 310, DEARBORN HEIGHTS, MI 48127-0310
(562) 213-5621
Mailing address
PO BOX 310, DEARBORN HEIGHTS, MI 48127-0310
(562) 213-5621
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
3336M0002X
Mail Order Pharmacy
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
5802020115
MI
347C00000X
Private Vehicle
—
—
Other
Enumeration date
04/07/2025
Last updated
04/30/2025
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