Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 4301100629 | MI |
N | 207ND0900X | Dermatopathologist | 74802 | GA |
NPI | 1053547885 |
---|---|
Provider Name | Dr. Liaqat Ali |
First Address | Monroe, MI 48162-3131 |
Second Address | Monroe, MI 48162-3131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2009 |
Last Update Date | 18/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003171153A | (05) | GA |