Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5101015606 | MI |
Y | 207QS0010X | Family Doctor - Sports Medicine | 5101015606 | MI |
NPI | 1265649222 |
---|---|
Provider Name | Sadiq Haque |
First Address | Detroit, MI 48267-3671 |
Second Address | Warren, MI 48092-4272 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 18/02/2009 |