Provider Demographics
NPI:1669960944
Name:DOCTOR, PEZAD NOZER (MD)
Entity type:Individual
Prefix:MR
First Name:PEZAD
Middle Name:NOZER
Last Name:DOCTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 BEAUBIEN BLVD
Mailing Address - Street 2:PEDIATRIC EDUCATION OFFICE 3T-72, 3RD FLOOR
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-1892
Mailing Address - Fax:313-993-7118
Practice Address - Street 1:3901 BEAUBIEN BLVD
Practice Address - Street 2:PEDIATRIC EDUCATION OFFICE 3T-72, 3RD FLOOR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-1892
Practice Address - Fax:313-993-7118
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-12-10
Deactivation Date:2018-11-29
Deactivation Code:
Reactivation Date:2018-12-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program