Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301104197 | MI |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 4301104197 | MI |
NPI | 1003072463 |
---|---|
Provider Name | Dr. Alissa M Martin |
First Address | Detroit, MI 48201 |
Second Address | Detroit, MI 48201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 30/09/2013 |