Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 048418 | MI |
NPI | 1164473419 |
---|---|
Provider Name | Mohammad Yusaf |
First Address | Ann Arbor, MI 48105-1598 |
Second Address | Wyandotte, MI 48192-4668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 05/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3433526 | (05) | MI |
4842227 | (05) | MI |
A78415 | (02) | MI |
MY048418 | BLUE CROSS/BLUE SHIELD (01) | MI |