Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 4301062173 | MI |
NPI | 1174691695 |
---|---|
Provider Name | Haythem Y Ali |
First Address | Detroit, MI 48202 |
Second Address | Detroit, MI 48202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G83400 | (02) | |
HA062173 | CHAMPUS-CHAMPUS (01) | |
HA062173 | COMMERCIAL-COMMERCIAL NUMBER (01) |