Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301087507 | MI |
N | 208600000X | Surgeon | 4301087507 | MI |
Y | 2082S0105X | Plastic Hand Surgeon | 4301087507 | MI |
N | 208200000X | Surgeon | 4301087507 | MI |
N | 208600000X | Surgeon | 4301087507 | MI |
NPI | 1093880403 |
---|---|
Provider Name | Dr. Alberto Julian Aviles |
First Address | Warren, MI 48093-3490 |
Second Address | Warren, MI 48093-3400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 15/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
700E012740 | BCBSM GROUP NUMBER (01) | MI |