Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5101017811 | MI |
NPI | 1457507998 |
---|---|
Provider Name | Ahmed Maki |
First Address | Pontiac, MI 48342-2217 |
Second Address | Pontiac, MI 48342-2217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2008 |
Last Update Date | 15/08/2008 |