Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 4301063683 | MI |
NPI | 1376521922 |
---|---|
Provider Name | Dr. Ahmad Kaddurah |
First Address | Grand Blanc, MI 48480-0956 |
Second Address | Flint, MI 48503-5902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 09/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4612989 | (05) | MI |