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General NPI Number Information
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NPI Number | 1649668542
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Entity Type | Organization
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Legal Business Name | DOCTORS NETWORK PC
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 13530 MICHIGAN AVE
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City | DEARBORN
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State | MI
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Zip | 48126-3574
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Country | US
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Telephone | 734-673-5917
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Fax | 314-667-6915
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Provider Business Mailing Address
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Address Line | 23169 MICHIGAN AVE SUITE #23135
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City | DEARBORN
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State | MI
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Zip | 48124-0001
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Country | US
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Telephone | 734-673-5917
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Fax | 314-667-6915
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Authorized Official
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Title or Position | PRESIDENT
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Name | ATIF BAWAHAB
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Credential |
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Telephone | 810-813-4094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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