Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | CD084925 | MI |
NPI | 1003820648 |
---|---|
Provider Name | Carrie L Dul |
First Address | Grosse Pointe Woods, MI 48236-2857 |
Second Address | Grosse Pointe Woods, MI 48236-2857 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 26/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0824230 | BCN (01) | MI |
0H208910 | BLUE CROSS (01) | MI |
4751900 | (05) | MI |
4751928 | (05) | MI |
I18926 | (02) | MI |