Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 4351038200 | MI |
NPI | 1255836409 |
---|---|
Provider Name | Rim Soliman Ishak |
First Address | Detroit, MI 48202-3046 |
Second Address | Detroit, MI 48202-3046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2018 |
Last Update Date | 08/11/2021 |