Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301094483 | MI |
N | 111NI0900X | Internist | 4301094483 | MI |
Y | 207RG0300X | Geriatric Medicine | 16467 | NH |
NPI | 1053543983 |
---|---|
Provider Name | Masooma Athar |
First Address | Detroit, MI 48201-2153 |
Second Address | Detroit, MI 48201-2153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 25/03/2014 |