Individual
BAHER KAMELISHACC BOCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3990 JOHN R ST, DETROIT, MI 48201-2018
(313) 745-8521
Mailing address
PO BOX 64000, DWR 641546, DETROIT, MI 48264-0001
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4301056652
MI
Other
Enumeration date
06/18/2006
Last updated
09/20/2012
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