Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 012353 | MI |
Y | 213EG0000X | General Practice | 012353 | MI |
NPI | 1003946518 |
---|---|
Provider Name | Dr. Randal Alan Bourjaily |
First Address | Northville, MI 48167-9018 |
Second Address | Novi, MI 48377-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |