Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 302757 | LA |
Y | 207N00000X | Dermatologist | 4301505126 | MI |
N | 208D00000X | General Practice Physician | 309000 | LA |
NPI | 1003202409 |
---|---|
Provider Name | Rawaa Almukhtar |
First Address | Detroit, MI 48202-3450 |
Second Address | Detroit, MI 48202-3046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2015 |
Last Update Date | 15/07/2021 |