Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301089589 | MI |
N | 2080P0208X | Pediatric Infectious Diseases | 4301089589 | MI |
NPI | 1164623823 |
---|---|
Provider Name | Dr. Arsala Bakhtyar |
First Address | Southfield, MI 48033-3849 |
Second Address | Canton, MI 48187-1579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 22/10/2020 |