Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301093813 | MI |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 4301093813 | MI |
NPI | 1134385727 |
---|---|
Provider Name | Dr. Mustufa Yahya Boxwalla |
First Address | Detroit, MI 48202-2608 |
Second Address | Detroit, MI 48202-3450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2008 |
Last Update Date | 10/06/2009 |