Individual
FAITH WALID GAMMOUH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
259 MACK AVE, DETROIT, MI 48201-2427
(313) 577-1716
Mailing address
259 MACK AVE, DETROIT, MI 48201-2427
(313) 577-1716
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010551TMP21
MI
Other
Enumeration date
12/10/2020
Last updated
05/21/2021
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