Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301037615 | MI |
Y | 2080P0208X | Pediatric Infectious Diseases | 4301037615 | MI |
NPI | 1184661183 |
---|---|
Provider Name | Basim Isa Asmar |
First Address | Detroit, MI 48201 |
Second Address | Detroit, MI 48201-2119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 18/01/2017 |