Healthcare Provider Details

I. General information

NPI: 1447469176
Provider Name (Legal Business Name): ABBAS BAHARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N MONROE ST
MONROE MI
48162-4211
US

IV. Provider business mailing address

1 SEAGATE STE 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-8480
  • Fax: 734-384-0469
Mailing address:
  • Phone: 567-585-1992
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35134956
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA121722
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number4301087953
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: