Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | IH067985 | MI |
NPI | 1538117866 |
---|---|
Provider Name | Dr. Iltefat H Hamzavi |
First Address | Clinton Twp, MI 48038-6306 |
Second Address | Canton, MI 48187-3907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 09/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4366016 | (05) | MI |
4366320 | (05) | MI |
CB4874 | RAILROAD MEDICARE (01) | MI |
H50172 | (02) | MI |