Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301098146 | MI |
N | 111NI0900X | Internist | 4301098146 | MI |
N | 207RC0000X | Internist - Cardiovascular Disease | 4301098146 | MI |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 4301098146 | MI |
NPI | 1023301900 |
---|---|
Provider Name | Michael Mousa-Jabra Ghannam |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2011 |
Last Update Date | 19/10/2020 |