Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301093862 | MI |
Y | 111NI0900X | Internist | 4301093862 | MI |
N | 207R00000X | Internist | 51642 | SC |
N | 111NI0900X | Internist | 51642 | SC |
N | 207U00000X | Nuclear Medicine Specialist | 51642 | SC |
NPI | 1255561189 |
---|---|
Provider Name | Mohammed Taoudi Benchekroun |
First Address | Royal Oak, MI 48073-6712 |
Second Address | Royal Oak, MI 48073-6712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2009 |
Last Update Date | 10/09/2019 |