Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 4301502151 | MI |
Y | 208000000X | Pediatrician | 4301502151 | MI |
NPI | 1245768738 |
---|---|
Provider Name | Ahmed Elisa |
First Address | Detroit, MI 48202 |
Second Address | Kalamazoo, MI 49008-1282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2017 |
Last Update Date | 24/01/2022 |