Provider Demographics
NPI:1922199850
Name:MUSTAFA S BOHRA MD PLC
Entity Type:Organization
Organization Name:MUSTAFA S BOHRA MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-582-2142
Mailing Address - Street 1:6950 CARLYLE CROSSING
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3082
Mailing Address - Country:US
Mailing Address - Phone:313-582-2142
Mailing Address - Fax:313-582-8627
Practice Address - Street 1:15120 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2916
Practice Address - Country:US
Practice Address - Phone:313-582-2142
Practice Address - Fax:313-582-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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