Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 5901400399 | MI |
NPI | 1083103329 |
---|---|
Provider Name | Raed Al Gharib |
First Address | Warren, MI 48092-2203 |
Second Address | Warren, MI 48092-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2018 |
Last Update Date | 15/07/2021 |