Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301113420 | MI |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 4301113420 | MI |
NPI | 1265954473 |
---|---|
Provider Name | Ali Hikmat Mahmood |
First Address | Van Buren Twp, MI 48111-3443 |
Second Address | Van Buren Twp, MI 48111-3443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2017 |
Last Update Date | 14/04/2021 |