Provider Demographics
NPI:1699787200
Name:BOHRA, BAHADUR S (MD)
Entity type:Individual
Prefix:
First Name:BAHADUR
Middle Name:S
Last Name:BOHRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2319
Mailing Address - Country:US
Mailing Address - Phone:313-388-0021
Mailing Address - Fax:313-388-9464
Practice Address - Street 1:1336 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2319
Practice Address - Country:US
Practice Address - Phone:313-388-0021
Practice Address - Fax:313-388-9464
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBB043408207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2114557-10Medicaid
A73606Medicare UPIN
MI2114557-10Medicaid