Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101019529 | MI |
NPI | 1679869192 |
---|---|
Provider Name | Dr. Faheem Ejaz |
First Address | Wyoming, MI 49519-9606 |
Second Address | Wyoming, MI 49519-9606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 22/06/2011 |