Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | RD057506 | MI |
NPI | 1033131941 |
---|---|
Provider Name | Dr. Renda K Dawud |
First Address | Southfield, MI 48034 |
Second Address | Southfield, MI 48034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 03/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F00616 | (02) | MI |