Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301086417 | MI |
NPI | 1003022641 |
---|---|
Provider Name | Danish Mazhar |
First Address | Troy, MI 48085-1065 |
Second Address | Troy, MI 48085-1065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 28/09/2009 |