Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 5101022515 | MI |
Y | 111NI0900X | Internist | 5101022515 | MI |
NPI | 1003279761 |
---|---|
Provider Name | Ahmed Elbanna |
First Address | Grosse Ile, MI 48138-1853 |
Second Address | Detroit, MI 48202-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2016 |
Last Update Date | 12/05/2020 |