Healthcare Provider Details

I. General information

NPI: 1912905340
Provider Name (Legal Business Name): ALEX BOUHACHEM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
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:
Mailing address:
  • Phone: 734-895-4530
  • Fax: 313-447-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: