Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 4301056937 | MI |
N | 208000000X | Pediatrician | 4301056937 | MI |
NPI | 1144688854 |
---|---|
Provider Name | Dr. Hussein Azzam |
First Address | Novi, MI 48377-2460 |
Second Address | Novi, MI 48377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2016 |
Last Update Date | 29/08/2018 |