Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301089248 | MI |
Y | 111NI0900X | Internist | 4301089248 | MI |
NPI | 1003034455 |
---|---|
Provider Name | Hany S Mesiha |
First Address | Berrien Springs, MI 49103-9501 |
Second Address | Saint Joseph, MI 49085-2112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 05/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1101111302 | BLUE CROSS PIN (01) | MI |
5190033 | (05) | MI |
FM0260048 | DEA (01) | MI |