Healthcare Provider Details

I. General information

NPI: 1730187295
Provider Name (Legal Business Name): THAKURDEO MICHAEL BHIRO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL BHIRO PA

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18901 IDA MILL RD
LAUREL HILL NC
28351-8326
US

IV. Provider business mailing address

821 AUSTIN ST
HAMLET NC
28345-3001
US

V. Phone/Fax

Practice location:
  • Phone: 910-462-2707
  • Fax: 910-462-4184
Mailing address:
  • Phone: 910-582-8452
  • Fax: 910-462-4184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number101561
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: