Provider Demographics
NPI:1124237516
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:313-406-4201
Mailing Address - Fax:313-406-4293
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:313-406-4201
Practice Address - Fax:313-406-4293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213ES0103X
MI5901002050332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty