Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 5101019321 | MI |
N | 207QS0010X | Family Doctor - Sports Medicine | 5101019321 | MI |
NPI | 1033406368 |
---|---|
Provider Name | Dr. Noshir Yazdi Amaria |
First Address | Mt Pleasant, MI 48859-0001 |
Second Address | Mt Pleasant, MI 48859-1811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2011 |
Last Update Date | 12/10/2017 |