Provider Demographics
NPI:1265465769
Name:BAHRAINWALA, ABDUL H (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:H
Last Name:BAHRAINWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 W 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6711
Mailing Address - Country:US
Mailing Address - Phone:248-549-0777
Mailing Address - Fax:248-549-5888
Practice Address - Street 1:3600 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6711
Practice Address - Country:US
Practice Address - Phone:248-549-0777
Practice Address - Fax:248-549-5888
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI059947207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4620748Medicaid
MI3508285581OtherBLUE CROSS
MIF95073Medicare UPIN