Individual
POUYA ENTEZAMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 263-2300
(313) 876-1305
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 876-4806
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
4301506804
MI
390200000X
Student in an Organized Health Care Education/Training Program
63597
NY
Other
Enumeration date
03/24/2015
Last updated
03/27/2023
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