Provider Demographics
NPI:1447827894
Name:RIVERVIEW NEUROMUSCULAR PAIN CENTER PLLC
Entity type:Organization
Organization Name:RIVERVIEW NEUROMUSCULAR PAIN CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOUSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-241-2491
Mailing Address - Street 1:7633 E JEFFERSON AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3731
Mailing Address - Country:US
Mailing Address - Phone:313-740-1111
Mailing Address - Fax:313-672-6241
Practice Address - Street 1:7633 E JEFFERSON AVE STE 170
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3731
Practice Address - Country:US
Practice Address - Phone:313-740-1111
Practice Address - Fax:313-672-6241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty