Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301047649 | MI |
N | 208600000X | Surgeon | 4301047649 | MI |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 4301047649 | MI |
NPI | 1083779623 |
---|---|
Provider Name | Rouchdi M Rifai |
First Address | Southfield, MI 48076-7729 |
Second Address | Southfield, MI 48076-7729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 28/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4301047649 | LICENSE (01) | MI |