Healthcare Provider Details

I. General information

NPI: 1831522655
Provider Name (Legal Business Name): MHD-HUSSAM DIARBAKRLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HUSSAM BAKRLI M.D.

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23611 GODDARD RD SUITE B
TAYLOR MI
48180-4046
US

IV. Provider business mailing address

23611 GODDARD RD SUITE B
TAYLOR MI
48180-4046
US

V. Phone/Fax

Practice location:
  • Phone: 734-250-7887
  • Fax: 734-250-8091
Mailing address:
  • Phone: 734-250-7887
  • Fax: 734-250-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301056799
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: