Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5101018420 | MI |
NPI | 1639402258 |
---|---|
Provider Name | Dr. Shant Ara Korkigian |
First Address | Novi, MI 48375-1882 |
Second Address | Novi, MI 48375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2009 |
Last Update Date | 15/06/2021 |