Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301070129 | MI |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 4301070129 | MI |
NPI | 1285695874 |
---|---|
Provider Name | Homa Hasnain |
First Address | Detroit, MI 48235 |
Second Address | Detroit, MI 48235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 06/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080H262390 | BLUE CROSS-BLUE CROSS (01) | |
494477310 | (05) | MI |
H77176 | (02) | |
HH070129 | CHAMPUS-CHAMPUS (01) | |
HH070129 | COMMERCIAL-COMMERCIAL NUMBER (01) |