Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301504386 | MI |
N | 111NI0900X | Internist | 4301504386 | MI |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 4301504386 | MI |
N | 207RC0000X | Internist - Cardiovascular Disease | 4301504386 | MI |
NPI | 1275917064 |
---|---|
Provider Name | Andrew Roshdy Boshara |
First Address | Detroit, MI 48202-2608 |
Second Address | Detroit, MI 48202-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2015 |
Last Update Date | 01/07/2021 |