Individual
KEFAH ABBAS MAZLOUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-7836
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704341497
MI
Other
Enumeration date
01/19/2022
Last updated
03/17/2025
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