Individual
WESSAM BOUTROS BOU-ASSALY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2155 FULLER RD, RADIOLOGY DEPARTMENT/ VA HEALTH CENTER, ANN ARBOR, MI 48105
(734) 761-7959
Mailing address
9155 MIRAGE LAKE DR, MILAN, MI 48160-9010
(317) 828-0810
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4301089243
MI
2085N0700X
Neuroradiology Physician
4301089243
MI
2085R0202X
Diagnostic Radiology Physician
4301089243
MI
2085R0202X
Diagnostic Radiology Physician
Primary
M41968
TX
Other
Enumeration date
07/28/2007
Last updated
10/01/2025
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