Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 4301064015 | MI |
NPI | 1457321481 |
---|---|
Provider Name | Ayse P Cemeroglu |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 27/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1558407189 | GROUP NPI (01) | MI |
3504111831 | BCBSM (01) | MI |
4384346 | (05) | MI |
I51594 | (02) | MI |