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General NPI Number Information
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NPI Number | 1699432286
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Entity Type | Organization
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Legal Business Name | ALLEN PRIMARY PODIATRY
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 23801 W WARREN ST STE 102
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-2277
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Country | US
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Telephone | 734-895-4530
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Fax | 313-447-3234
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Provider Business Mailing Address
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Address Line | 1813 N ROSEVERE AVE
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City | DEARBORN
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State | MI
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Zip | 48128-1242
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Country | US
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Telephone | 734-895-4530
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Fax | 313-447-3234
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Authorized Official
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Title or Position | CEO
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Name | ALEX BOUHACHEM
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Credential | DPM
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Telephone | 734-895-4530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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