Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2333134 | MI |
NPI | 1124461579 |
---|---|
Provider Name | Dr. Sarmad Mazin Alyas |
First Address | Troy, MI 48098-4106 |
Second Address | Livonia, MI 48152-1050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2013 |
Last Update Date | 19/06/2016 |