Healthcare Provider Details

I. General information

NPI: 1477898898
Provider Name (Legal Business Name): ALA-EDDIN BARHAM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST SUITE 1017
DETROIT MI
48201-2020
US

IV. Provider business mailing address

6610 HARTWELL ST APARTMENT # 2
DEARBORN MI
48126-1880
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4123
  • Fax:
Mailing address:
  • Phone: 313-230-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301101837
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: