Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 4301050791 | MI |
N | 208200000X | Surgeon | 4301050791 | MI |
N | 208600000X | Surgeon | 4301050791 | MI |
NPI | 1316000896 |
---|---|
Provider Name | Marwan S. Abouljoud |
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 | 18/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F27036 | (02) | |
MA050791 | CHAMPUS-CHAMPUS (01) | |
MA050791 | COMMERCIAL-COMMERCIAL NUMBER (01) |