Individual
DR. BAHRAM ELAMI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
724 W CENTRE AVE, 105, PORTAGE, MI 49024-6310
(269) 327-3700
(269) 323-0229
Mailing address
724 W CENTRE AVE, SUITE 105, PORTAGE, MI 49024-6310
(269) 327-3700
(269) 323-0229
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
4301068834
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301068834
MICHIGAN LICENSE
MI
05
—
4421824
—
MI
01
—
81-0557140
EMPLOYERS ID
MI
Enumeration date
10/27/2006
Last updated
02/28/2013
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