Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 5101024606 | MI |
NPI | 1386094548 |
---|---|
Provider Name | Brooke Blazius |
First Address | Ann Arbor, MI 48109-4000 |
Second Address | Ann Arbor, MI 48109-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2016 |
Last Update Date | 14/06/2019 |