Individual
HARVEY BOURU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1770 FORT ST, LINCOLN PARK, MI 48146-1904
(313) 753-0016
Mailing address
5346 CLIPPERT ST, DEARBORN HEIGHTS, MI 48125-2740
(313) 753-0016
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601009896
MI
Other
Enumeration date
06/16/2020
Last updated
06/16/2020
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