Individual
MD S MIAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11350 JOSEPH CAMPAU ST, HAMTRAMCK, MI 48212-3039
(313) 742-2397
Mailing address
1981 DEVEERE DR, STERLING HEIGHTS, MI 48310-5853
(313) 742-2397
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8261491
—
MI
Enumeration date
02/12/2019
Last updated
02/12/2019
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