Healthcare Provider Details

I. General information

NPI: 1942596242
Provider Name (Legal Business Name): BERNARD ANGELLO ACHO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 OAKWOOD BLVD
DEARBORN MI
48124-2319
US

IV. Provider business mailing address

PO BOX 2802
DEARBORN MI
48123-2929
US

V. Phone/Fax

Practice location:
  • Phone: 313-359-7600
  • Fax:
Mailing address:
  • Phone: 313-359-7600
  • Fax: 313-359-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301098857
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: