Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 5501017117 | MI |
NPI | 1225406820 |
---|---|
Provider Name | Enas Eraqi |
First Address | Center Line, MI 48015-1779 |
Second Address | Wayne, MI 48184-2405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2015 |
Last Update Date | 13/09/2015 |