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Individual

ISRA IDRIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3901 BEAUBIEN ST, DETROIT, MI 48201-2119
(571) 484-2860
Mailing address
3800 WOODWARD AVE APT 306, DETROIT, MI 48201-1978
(571) 484-2860

Taxonomy

Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1356966691
NPI
NY
01
691977830
LEARNER PERMIT
NY
Enumeration date
12/14/2022
Last updated
07/19/2023
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