Provider Demographics
NPI:1467407080
Name:HICHAM A. EL-HORR MD, PC
Entity Type:Organization
Organization Name:HICHAM A. EL-HORR MD, PC
Other - Org Name:DEARBORN FAMILY MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HICHAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:EL-HORR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-606-1600
Mailing Address - Street 1:PO BOX 3087
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-0087
Mailing Address - Country:US
Mailing Address - Phone:313-624-3011
Mailing Address - Fax:313-624-3012
Practice Address - Street 1:5728 SCHAEFER RD
Practice Address - Street 2:SUITE 204
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2298
Practice Address - Country:US
Practice Address - Phone:313-624-3011
Practice Address - Fax:313-624-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080H232090OtherBCN
MI024693OtherMIDWEST
MA0808249182OtherBCBS
MI080H232090OtherBCBS
MI0808249182OtherBCN
MI481080Medicaid
MI7069810OtherAETNA
MIDP2143OtherRAILROAD MEDICARE
MI7069810OtherAETNA