Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101020497 | MI |
NPI | 1003252230 |
---|---|
Provider Name | Lina Rayes Yousif |
First Address | Clinton Township, MI 48038-6327 |
Second Address | Clinton Township, MI 48038-6327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2013 |
Last Update Date | 01/03/2017 |