Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301055070 | MI |
N | 207PE0004X | Emergency Medical Services | 4301055070 | MI |
NPI | 1114987187 |
---|---|
Provider Name | Dr. Alvan R Cruz |
First Address | Ypsilanti, MI 48198 |
Second Address | Detroit, MI 48201-2153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 18/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103309516 | (05) | MI |
103309534 | (05) | MI |
AC055070 | BC/BS OF MI (01) | MI |
F01778 | (02) | MI |