Provider Demographics
NPI:1649668542
Name:DOCTORS NETWORK PC
Entity type:Organization
Organization Name:DOCTORS NETWORK PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATIF
Authorized Official - Middle Name:
Authorized Official - Last Name:BAWAHAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-813-4094
Mailing Address - Street 1:23169 MICHIGAN AVE
Mailing Address - Street 2:SUITE #23135
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-0001
Mailing Address - Country:US
Mailing Address - Phone:734-673-5917
Mailing Address - Fax:314-667-6915
Practice Address - Street 1:13530 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3574
Practice Address - Country:US
Practice Address - Phone:734-673-5917
Practice Address - Fax:314-667-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty