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General NPI Number Information
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NPI Number | 1922199850
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Entity Type | Organization
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Legal Business Name | MUSTAFA S BOHRA MD PLC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 15120 MICHIGAN AVE
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City | DEARBORN
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State | MI
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Zip | 48126-2916
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Country | US
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Telephone | 313-582-2142
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Fax | 313-582-8627
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Provider Business Mailing Address
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Address Line | 6950 CARLYLE CROSSING
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3082
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Country | US
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Telephone | 313-582-2142
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Fax | 313-582-8627
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Authorized Official
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Title or Position | OWNER
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Name | MUSTAFA S BOHRA
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Credential | MD
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Telephone | 313-582-2142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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