Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 4301106632 | MI |
NPI | 1598083024 |
---|---|
Provider Name | Mr. Mark Sabah Toma |
First Address | Dearborn, MI 48124-3043 |
Second Address | Dearborn, MI 48124-3043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2010 |
Last Update Date | 05/04/2016 |