Provider Demographics
NPI:1952146102
Name:BAKHIET, EBRAAM MOUNIR (OD)
Entity type:Individual
Prefix:
First Name:EBRAAM
Middle Name:MOUNIR
Last Name:BAKHIET
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 FEDORA DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4008
Mailing Address - Country:US
Mailing Address - Phone:248-953-1647
Mailing Address - Fax:
Practice Address - Street 1:2910 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7031
Practice Address - Country:US
Practice Address - Phone:248-435-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005796152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist