Provider Demographics
NPI:1962685271
Name:NADA D BACHURI MD,PC
Entity Type:Organization
Organization Name:NADA D BACHURI MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-828-8900
Mailing Address - Street 1:41069 DEQUINDRE RD
Mailing Address - Street 2:STE 101
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:
Practice Address - Street 1:41069 DEQUINDRE RD
Practice Address - Street 2:STE 101
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty