Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 4301049200 | MI |
NPI | 1013902691 |
---|---|
Provider Name | Ayad M. Al-Katib |
First Address | Grosse Pointe Woods, MI 48236-2858 |
Second Address | Grosse Pointe Woods, MI 48236-2858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4327573 | (05) | MI |
B49277 | (02) | MI |