Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 60641 | MN |
NPI | 1114290442 |
---|---|
Provider Name | Dr. Said Haider Al Tawil |
First Address | Red Wing, MN 55066-2848 |
Second Address | Red Wing, MN 55066-2848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2012 |
Last Update Date | 16/09/2016 |