Individual
BAHAE MOHAMMED EBRAHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12815 NORTHLINE RD, SOUTHGATE, MI 48195-1109
(734) 284-2090
Mailing address
12815 NORTHLINE RD, SOUTHGATE, MI 48195-1109
(734) 284-2090
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301089436
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105222450
—
MI
Enumeration date
08/19/2007
Last updated
04/09/2013
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