Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 4301104614 | MI |
NPI | 1710148002 |
---|---|
Provider Name | Ahmed Sufyan |
First Address | East Lansing, MI 48823-1222 |
Second Address | East Lansing, MI 48823-1222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 26/03/2019 |