Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | NH033036 | MI |
NPI | 1104889674 |
---|---|
Provider Name | Dr. Naseer Humayun |
First Address | Jackson, MI 49201-1674 |
Second Address | Jackson, MI 49201-1674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 03/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1244495-10 | (05) | MI |
F76198 | (02) | MI |