Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 4301109538 | MI |
N | 207N00000X | Dermatologist | 5315075625 | MI |
N | 207NS0135X | Procedural Dermatology | 4301109538 | MI |
N | 207NS0135X | Procedural Dermatology | 5315075625 | MI |
N | 208200000X | Surgeon | 4301109538 | MI |
N | 208600000X | Surgeon | 4301109538 | MI |
N | 208200000X | Surgeon | 5315075625 | MI |
N | 208600000X | Surgeon | 5315075625 | MI |
NPI | 1366804569 |
---|---|
Provider Name | Hany Deirawan |
First Address | Detroit, MI 48201-1928 |
Second Address | Dearborn, MI 48124-4085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2016 |
Last Update Date | 18/11/2021 |