Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 14794 | NV |
N | 208600000X | Surgeon | 14794 | NV |
Y | 208200000X | Surgeon | 4301106555 | MI |
Y | 208600000X | Surgeon | 4301106555 | MI |
N | 208200000X | Surgeon | MD445621 | PA |
N | 208600000X | Surgeon | MD445621 | PA |
N | 2082S0105X | Plastic Hand Surgeon | MD445621 | PA |
N | 2086S0105X | Surgery of the Hand | 4301106555 | MI |
NPI | 1508116914 |
---|---|
Provider Name | Dr. Khalid Mutlag Almutairi |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48823-5376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2012 |
Last Update Date | 08/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1508116914 | (05) | MI |