Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1023617727 |
---|---|
Provider Name | Suraiya Matin |
First Address | Bingham Farms, MI 48025-2452 |
Second Address | Bingham Farms, MI 48025-2452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2020 |
Last Update Date | 22/10/2020 |