Provider Demographics
NPI:1164502555
Name:HANA BACHURI, NADA (MD)
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:HANA BACHURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41069 DEQUINDRE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-6730
Mailing Address - Country:US
Mailing Address - Phone:248-828-8900
Mailing Address - Fax:248-828-8909
Practice Address - Street 1:41069 DEQUINDRE RD STE 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-6730
Practice Address - Country:US
Practice Address - Phone:248-828-8900
Practice Address - Fax:248-828-8909
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII45695Medicare UPIN