Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 4301406704 | MI |
Y | 207RA0401X | Internist - Addiction Medicine | 4301406704 | MI |
NPI | 1205856044 |
---|---|
Provider Name | Dr. Beverly L Blaney |
First Address | Southfield, MI 48034-2005 |
Second Address | Saint Clair Shores, MI 48080-1655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F10255 | (02) | MI |