Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 4301096725 | MI |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 4301096725 | MI |
NPI | 1760792311 |
---|---|
Provider Name | Asghar Khaghani |
First Address | Grand Rapids, MI 49503 |
Second Address | Grand Rapids, MI 49503-2556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2010 |
Last Update Date | 03/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1760792311 | (05) | MI |