Individual
BASEL BRIKHO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18211 W 12 MILE RD, LATHRUP VILLAGE, MI 48076
(248) 557-4443
(248) 557-0573
Mailing address
18211 W 12 MILE RD, LATHRUP VILLAGE, MI 48076
(248) 557-4443
(248) 557-0573
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301061420
MI
208000000X
Pediatrics Physician
4301061420
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
383461699
TAX ID
MI
05
—
4092397
—
MI
01
—
BB061420
LICENSE
MI
Enumeration date
10/06/2006
Last updated
07/06/2017
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