Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 4301056382 | MI |
NPI | 1568421329 |
---|---|
Provider Name | Bishara Freij |
First Address | Troy, MI 48083-1103 |
Second Address | Royal Oak, MI 48073-6710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2662613 | (05) | MI |
350F361320 | BCBSM (01) | MI |
D09544 | (02) | MI |