Provider Demographics
NPI:1326146390
Name:BAJOUKA, NEERAN YOUSIF (MD)
Entity Type:Individual
Prefix:DR
First Name:NEERAN
Middle Name:YOUSIF
Last Name:BAJOUKA
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 1:300 55 NORTHWESTERN HWY
Mailing Address - Street 2:STE 160
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-865-4160
Mailing Address - Fax:248-865-4161
Practice Address - Street 1:30055 NORTHWESTERN HWY STE 160
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-865-4160
Practice Address - Fax:248-865-4161
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0632209OtherBC INDIVIDUAL PIN
MI143559OtherGREAT LAKES HEALTH PLAN
MIH02606OtherHAP ID
MI4582763Medicaid
MI9063OtherCAPE HEALTH ID
MI9063OtherCAPE HEALTH ID
MI0N82350Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER