Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301052487 | MI |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 4301052487 | MI |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 4301052487 | MI |
N | 208200000X | Surgeon | 4301052487 | MI |
N | 208600000X | Surgeon | 4301052487 | MI |
N | 2086S0122X | Plastic and Reconstructive Surgery | 4301052487 | MI |
NPI | 1629247481 |
---|---|
Provider Name | Haitham Masri |
First Address | Dearborn, MI 48126-3574 |
Second Address | Dearborn, MI 48126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2008 |
Last Update Date | 17/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0408205571 | BCBS IND (01) | MI |
1629247481 | (05) | MI |
4867754 | (05) | MI |
700H228180 | BLUE CROSS BLUE SHIELD MI (01) | MI |
A83188 | (02) | MI |
P10167081 | RAILROAD MEDICARE (01) | MI |