Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 5101020040 | MI |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101020040 | MI |
NPI | 1508129123 |
---|---|
Provider Name | Dr. Devin T Mistry |
First Address | Wyoming, MI 49509 |
Second Address | Wyoming, MI 49509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2012 |
Last Update Date | 20/08/2020 |