Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 4301095424 | MI |
Y | 208D00000X | General Practice Physician | 4301095424 | MI |
NPI | 1134452501 |
---|---|
Provider Name | Mounir Mikhaeil |
First Address | Troy, MI 48099-1239 |
Second Address | Troy, MI 48084-4134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2009 |
Last Update Date | 04/03/2021 |