Basic Information
| Provider Information | |||||||||
| NPI: | 1780173898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRIKHO | ||||||||
| FirstName: | BASHAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35450 DEQUINDRE RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483104810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862742979 | ||||||||
| FaxNumber: | 2488495324 | ||||||||
| Practice Location | |||||||||
| Address1: | 35450 DEQUINDRE RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483104810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862742979 | ||||||||
| FaxNumber: | 2488495324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2018 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 4301505327 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1780173898 | 01 | MI | . | OTHER |