Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 4301067785 | MI |
NPI | 1477547297 |
---|---|
Provider Name | Rand Abdulnour-Farjo |
First Address | Detroit, MI 48236-2169 |
Second Address | Detroit, MI 48236-2169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 10/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4455027 | (05) | MI |
H78105 | (02) |