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Individual

MR. MUSTAFA SIRAJ BOHRA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
15120 MICHIGAN AVE, DEARBORN, MI 48126-2916
(313) 582-2142
Mailing address
6950 CARLYLE CROSSING, WEST BLOOMFIELD, MI 48322-3082
(248) 471-5469
(248) 478-5307

Taxonomy

Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
4301067914
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4566492
MI
01
743107704
TAX IDENTIFICATION
MI
Enumeration date
10/03/2005
Last updated
06/24/2008
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