Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 4301056551 | MI |
NPI | 1003806217 |
---|---|
Provider Name | Rula Mahayni |
First Address | Bloomfield Hills, MI 48302-5060 |
Second Address | Bloomfield Hills, MI 48302-5060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3177506 | (05) | MI |
4406343361 | BLUE CROSS (01) | MI |
G18106 | (02) |