Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301112414 | MI |
Y | 111NI0900X | Internist | 4301112414 | MI |
N | 207RG0300X | Geriatric Medicine | 4301112414 | MI |
NPI | 1083144596 |
---|---|
Provider Name | Tarig Elraiyah |
First Address | Dearborn, MI 48124-4089 |
Second Address | Dearborn, MI 48124-4089 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2017 |
Last Update Date | 16/06/2017 |