Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301066198 | MI |
NPI | 1205896032 |
---|---|
Provider Name | Dr. Cynthia Ann Lepak |
First Address | Commerce Township, MI 48382-4434 |
Second Address | Commerce Township, MI 48382-4434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103481640 | (05) | MI |
104175248 | (05) | MI |
104308540 | (05) | MI |
CL066198 | BC/BS OF MI (01) | MI |
G74214 | (02) | MI |