Individual
EDIN BASIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 263-2950
Mailing address
45307 NORTHPORT DR, #3301, MACOMB, MI 48044-5326
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101017539
MI
Other
Enumeration date
02/07/2008
Last updated
02/07/2008
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