Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 014725 | ME |
N | 207YP0228X | Pediatric Otolaryngology | 014725 | ME |
NPI | 1992877013 |
---|---|
Provider Name | Dr. Osama Ea El Silimy |
First Address | Caribou, ME 04736-2101 |
Second Address | Caribou, ME 04736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 19/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G72704 | (02) | |
G72704 | MEDICARE B (01) |