Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 4301046965 | MI |
NPI | 1285679027 |
---|---|
Provider Name | Muzaffar Khan Awan |
First Address | Allen Park, MI 48101 |
Second Address | Allen Park, MI 48101-2009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 23/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A74507 | (02) | MI |