Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 2718 | CA |
N | 2080P0203X | Pediatric Critical Care Doctor | 4301105548 | MI |
NPI | 1114215431 |
---|---|
Provider Name | Asaad G Beshish |
First Address | Atlanta, GA 30341-5540 |
Second Address | Atlanta, GA 30322-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 21/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4301105548 | BOARD OF MEDICINE PHYSICIAN LICENSE (01) | MI |
5315065676 | BOARD OF PHARMACY CONTROLLED SUBSTANCE LICENSE (01) | MI |