Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301048108 | MI |
N | 207PE0004X | Emergency Medical Services | 4301048108 | MI |
NPI | 1073573366 |
---|---|
Provider Name | Dr. Alice Dea |
First Address | Grosse Pointe Park, MI 48230-1818 |
Second Address | Detroit, MI 48201-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 18/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101907266 | (05) | MI |
AD048108 | BC/BS OF MI (01) | MI |
F10109 | (02) | MI |