Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5101023262 | MI |
NPI | 1770024630 |
---|---|
Provider Name | Niki Patel |
First Address | Mount Clemens, MI 48043-2920 |
Second Address | Mount Clemens, MI 48043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2017 |
Last Update Date | 16/05/2018 |