Provider Demographics
NPI:1508329137
Name:AGABIGUM, BORA MUSTAFA (MD)
Entity type:Individual
Prefix:
First Name:BORA
Middle Name:MUSTAFA
Last Name:AGABIGUM
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 1:1072 SUGAR MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9680
Mailing Address - Country:US
Mailing Address - Phone:810-931-6239
Mailing Address - Fax:
Practice Address - Street 1:30055 NORTHWESTERN HWY STE 101
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3260
Practice Address - Country:US
Practice Address - Phone:248-865-4444
Practice Address - Fax:248-865-6161
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301511600207YX0901X, 207Y00000X
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program