Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5315032060 | MI |
NPI | 1003055971 |
---|---|
Provider Name | Casey Ashby |
First Address | Ferndale, MI 48220-2333 |
Second Address | Farmington Hills, MI 48336-5966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2009 |
Last Update Date | 16/02/2009 |