Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4301051796 | MI |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 4301051796 | MI |
NPI | 1043307838 |
---|---|
Provider Name | Cosmas J M Van De Ven |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-4276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 18/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2969559 | (05) | MI |
E91133 | (02) | MI |