Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301084044 | MI |
N | 111NI0900X | Internist | 4301084044 | MI |
Y | 207R00000X | Internist | 47906 | CT |
Y | 111NI0900X | Internist | 47906 | CT |
N | 207U00000X | Nuclear Medicine Specialist | 4301084044 | MI |
N | 207U00000X | Nuclear Medicine Specialist | 47906 | CT |
NPI | 1386857357 |
---|---|
Provider Name | Dr. Mehdi Djekidel |
First Address | Hamden, CT 06518-1153 |
Second Address | Hamden, CT 06518-1153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 28/01/2015 |