Healthcare Provider Details

I. General information

NPI: 1124237516
Provider Name (Legal Business Name): ALEX BOUHACHEM DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
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: 313-406-4201
  • Fax: 313-406-4293
Mailing address:
  • Phone: 313-406-4201
  • Fax: 313-406-4293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5901002050
License Number StateMI

VIII. Authorized Official

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