Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0011X | Interventional Cardiology | 4301084773 | MI |
Y | 2080P0202X | Pediatric Cardiologist | 4301084773 | MI |
NPI | 1053311779 |
---|---|
Provider Name | Yasser Al Khatib |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 14/04/2021 |