Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 24151 | WV |
Y | 207RP1001X | Pulmonary Disease | 24151 | WV |
NPI | 1053517540 |
---|---|
Provider Name | Ali Soueidan |
First Address | Bay City, MI 48708-7656 |
Second Address | Bay City, MI 48708-7656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 03/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810018693 | (05) | WV |
P00858195 | MEDICARE RAILROAD (01) |