Healthcare Provider Details

I. General information

NPI: 1013964584
Provider Name (Legal Business Name): DEARBORN MEDICAL SUPPLIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10645 W WARREN AVE
DEARBORN MI
48126-1540
US

IV. Provider business mailing address

10645 W WARREN AVE
DEARBORN MI
48126-1540
US

V. Phone/Fax

Practice location:
  • Phone: 313-415-4667
  • Fax: 313-581-8377
Mailing address:
  • Phone: 313-415-4667
  • Fax: 313-581-8377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM BOUHACHEM
Title or Position: CEO
Credential:
Phone: 313-415-4667