Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301099510 | MI |
N | 207VX0000X | Obstetrician | 4301099510 | MI |
NPI | 1104114040 |
---|---|
Provider Name | Andrew Doherty |
First Address | Ann Arbor, MI 48105-9484 |
Second Address | Ypsilanti, MI 48197-0861 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2011 |
Last Update Date | 17/01/2022 |