Provider Demographics
NPI:1750548392
Name:BASEL A BRIKHO MD PC
Entity type:Organization
Organization Name:BASEL A BRIKHO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRIKHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-557-4443
Mailing Address - Street 1:18211 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2641
Mailing Address - Country:US
Mailing Address - Phone:248-557-4443
Mailing Address - Fax:248-557-0573
Practice Address - Street 1:18211 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2641
Practice Address - Country:US
Practice Address - Phone:248-557-4443
Practice Address - Fax:248-557-0573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty