Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301102575 | MI |
Y | 2080P0202X | Pediatric Cardiologist | 4301102575 | MI |
NPI | 1194161612 |
---|---|
Provider Name | Clinton Cochran |
First Address | Southfield, MI 48033-3849 |
Second Address | Royal Oak, MI 48073-6712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2013 |
Last Update Date | 21/01/2022 |