Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 4301083132 | MI |
NPI | 1083735294 |
---|---|
Provider Name | Dr. Shahryar Keikhosrow Kavoussi |
First Address | Ann Arbor, MI 48109-0999 |
Second Address | Ann Arbor, MI 48109-0999 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |