Provider Demographics
NPI:1932250149
Name:ALEX BOUHACHEM DPM PC
Entity Type:Organization
Organization Name:ALEX BOUHACHEM DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUHACHEM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-406-4201
Mailing Address - Street 1:1813 N ROSEVERE AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1242
Mailing Address - Country:US
Mailing Address - Phone:734-895-4530
Mailing Address - Fax:313-447-3234
Practice Address - Street 1:10801 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1191
Practice Address - Country:US
Practice Address - Phone:734-895-4530
Practice Address - Fax:313-447-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002050213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P30250Medicare PIN
MI5897750001Medicare NSC