Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 406869 | MI |
NPI | 1033134317 |
---|---|
Provider Name | Dr. Mohamad Y Tawila |
First Address | Royal Oak, MI 48073-6711 |
Second Address | Royal Oak, MI 48073-6711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0306367352 | BLUE CROSS (01) | MI |
4620659 | (05) | MI |
E80232 | (02) | MI |