Provider Demographics
NPI:1477898898
Name:BARHAM, ALA-EDDIN (MD)
Entity type:Individual
Prefix:DR
First Name:ALA-EDDIN
Middle Name:
Last Name:BARHAM
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 1:6610 HARTWELL ST
Mailing Address - Street 2:APARTMENT # 2
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1880
Mailing Address - Country:US
Mailing Address - Phone:313-230-8368
Mailing Address - Fax:
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:SUITE 1017
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-745-4123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101837208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology