Healthcare Provider Details

I. General information

NPI: 1598951931
Provider Name (Legal Business Name): COMMUNITY BRIDGES MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 10/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OAKLAND AVE 1ST FLOOR, SUITE E
PONTIAC MI
48342-2019
US

IV. Provider business mailing address

PO BOX 489
LINDEN MI
48451-0489
US

V. Phone/Fax

Practice location:
  • Phone: 734-347-1462
  • Fax: 810-458-4187
Mailing address:
  • Phone: 734-347-1462
  • Fax: 810-458-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301021837
License Number StateMI

VIII. Authorized Official

Name: DR. IBRAHAM I. AHMED
Title or Position: OWNER/ADMINSITRATOR
Credential: PH.D, R.N.
Phone: 734-347-1462