Provider Demographics
NPI:1649000258
Name:KAMAL, MARIUM (RD)
Entity type:Individual
Prefix:
First Name:MARIUM
Middle Name:
Last Name:KAMAL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5895 BURNHAM RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-4019
Mailing Address - Country:US
Mailing Address - Phone:316-655-6392
Mailing Address - Fax:
Practice Address - Street 1:5895 BURNHAM RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-4019
Practice Address - Country:US
Practice Address - Phone:316-655-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86062840133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered