Individual
MATTHEW A MAZUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
829 N CENTER AVE, SUITE 140, GAYLORD, MI 49735-1595
(989) 731-7870
(989) 731-7837
Mailing address
850 N OTSEGO AVE, SUITE 1, GAYLORD, MI 49735-1568
(989) 731-7708
(989) 731-7929
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036119681
IL
207R00000X
Internal Medicine Physician
Primary
510102814
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376719781 1
—
IL
01
—
2220936
BCBS
IL
01
—
OF96004
MEDICARE GROUP NUMBER
MI
Enumeration date
05/06/2008
Last updated
12/23/2020
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