Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | SH042103 | MI |
NPI | 1104874411 |
---|---|
Provider Name | Dr. S L Husain Hamzavi |
First Address | Clinton Twp, MI 48038-6306 |
Second Address | Clinton Twp, MI 48038-6306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 19/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1726888 | (05) | MI |
2113872 | (05) | MI |
CB4874 | RAILROAD MEDICARE (01) | MI |
F09793 | (02) | MI |