Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301090905 | MI |
Y | 2080P0214X | Pediatric Pulmonologist | 4301090905 | MI |
N | 2080P0214X | Pediatric Pulmonologist | 5315032876 | MI |
NPI | 1649479411 |
---|---|
Provider Name | Dr. Antonia Petrova Popova |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-4234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 03/04/2014 |