Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 4301049522 | MI |
NPI | 1023015450 |
---|---|
Provider Name | Betty Yu Go |
First Address | Clinton Twp, MI 48038-1135 |
Second Address | Southfield, MI 48075-4818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 15/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1991457/10 | (05) | MI |
B47928 | (02) | MI |