MEDICARE: ILYAS BOURCHID

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1497552053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILYAS BOURCHID

Provider Business Mailing Address
First Line	:	2331 FAR HILLS AVE STE 300
Second Line	:
City	:	OAKWOOD
State	:	OH
Zip	:	45419-1569
Country	:	US
Telephone Number	:	937-884-1087
Fax Number	:

Provider Business Practice Location Address
First Line	:	2331 FAR HILLS AVE STE 300
Second Line	:
City	:	OAKWOOD
State	:	OH
Zip	:	45419-1569
Country	:	US
Telephone Number	:	937-884-1087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	03/06/2025

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Directions to “ ILYAS BOURCHID ” Practice Location

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