Healthcare Provider Details

I. General information

NPI: 1932250149
Provider Name (Legal Business Name): ALEX BOUHACHEM DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 W WARREN AVE
DEARBORN MI
48126-1191
US

IV. Provider business mailing address

1813 N ROSEVERE AVE
DEARBORN MI
48128-1242
US

V. Phone/Fax

Practice location:
  • Phone: 734-895-4530
  • Fax: 313-447-3234
Mailing address:
  • Phone: 734-895-4530
  • Fax: 313-447-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002050
License Number StateMI

VIII. Authorized Official

Name: ALEX BOUHACHEM
Title or Position: CEO
Credential: DPM
Phone: 313-406-4201