Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | BS044631 | MI |
NPI | 1003966151 |
---|---|
Provider Name | Dr. Brenda L Sanford |
First Address | Waterford, MI 48328-1176 |
Second Address | Waterford, MI 48328-1176 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 26/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0F32915 | BCBS DURABLE MEDICAL SUPPLIER PIN# (01) | MI |
0F37553 | BLUE CROSS BLUE SHIELD MI (01) | MI |
1399040 | (05) | MI |
B46078 | (02) | MI |