Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 4301053444 | MI |
Y | 208D00000X | General Practice Physician | FM053444 | MI |
NPI | 1013180322 |
---|---|
Provider Name | Fatina Masri |
First Address | Dearborn, MI 48126-3575 |
Second Address | Dearborn, MI 48126-3574 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 10/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0808276302 | BCBS IND (01) | MI |
1013180322 | (05) | MI |
G97188 | (02) | MI |