Individual
EDSA MEHARY NEGUSSIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6245 INKSTER RD, GARDEN CITY, MI 48135-4001
(734) 458-3412
(734) 677-7407
Mailing address
PO BOX 1108, ATTN: LYNDA THOMPSON, ANN ARBOR, MI 48106-1108
(734) 677-7400
(734) 677-7407
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301068429
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3008133882
BCBS INDIVIDUAL PIN #
MI
05
—
4514988
—
MI
Enumeration date
07/08/2006
Last updated
07/09/2007
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