Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 01079155A | IN |
Y | 111NI0900X | Internist | 01079155A | IN |
NPI | 1003121930 |
---|---|
Provider Name | Ahmad Alhariri |
First Address | Fort Wayne, IN 46845-1703 |
Second Address | Fort Wayne, IN 46845-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2010 |
Last Update Date | 20/11/2017 |