Provider Demographics
NPI:1366698524
Name:BURHANI, HATIM TAHIR
Entity type:Individual
Prefix:
First Name:HATIM
Middle Name:TAHIR
Last Name:BURHANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24025 GREATER MACK AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-4311
Mailing Address - Country:US
Mailing Address - Phone:844-433-8980
Mailing Address - Fax:586-552-5326
Practice Address - Street 1:20835 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1486
Practice Address - Country:US
Practice Address - Phone:313-884-7566
Practice Address - Fax:313-884-3140
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002290213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery