Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301110072 | MI |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 4301110072 | MI |
NPI | 1245572460 |
---|---|
Provider Name | Mark Shamoun |
First Address | Detroit, MI 48201 |
Second Address | Detroit, MI 48201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 25/07/2019 |