Pouya Entezami, M.D.
Neurological Surgery in Clinton Township, MI. Individual provider (NPI-1).
NPI number1588058937
StatusActive
Last updated in NPPESMar 27, 2023
Details
- NPI
- 1588058937
- Entity type
- Individual (NPI-1)
- Name
- Pouya Entezami
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 24, 2015
- Certification date
- Mar 27, 2023
- Last updated
- Mar 27, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207T00000X | Neurological Surgery | 4301506804 | MI | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | 63597 | NY |
Practice location
15855 19 Mile RdClinton Township, MI 48038-3504
Phone 586-263-2300 · Fax 313-876-1305
Mailing address
1 Ford Pl Ste 3aDetroit, MI 48202-3450
Phone 313-876-4806 · Fax 313-876-1305
Other practice locations
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