Healthcare Provider Details

I. General information

NPI: 1609945864
Provider Name (Legal Business Name): MRS. DZEVADA BUKARIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 CARPENTER ST
HAMTRAMCK MI
48212-2766
US

IV. Provider business mailing address

3530 CARPENTER ST
HAMTRAMCK MI
48212-2766
US

V. Phone/Fax

Practice location:
  • Phone: 313-366-8500
  • Fax:
Mailing address:
  • Phone: 313-366-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: