Provider Demographics
NPI:1932527496
Name:BOKHARI, OMAIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAIMA
Middle Name:
Last Name:BOKHARI
Suffix:
Gender:F
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:PO BOX 32848
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-0848
Mailing Address - Country:US
Mailing Address - Phone:248-648-1225
Mailing Address - Fax:209-290-3018
Practice Address - Street 1:20280 MIDDLEBELT RD STE 500
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2002
Practice Address - Country:US
Practice Address - Phone:248-987-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301117187208100000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932527496Medicaid