Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4351044074 | MI |
NPI | 1003462771 |
---|---|
Provider Name | Dr. Wassim Mourad |
First Address | Louisville, KY 40202-3840 |
Second Address | Louisville, KY 40202-3840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2019 |
Last Update Date | 20/07/2020 |