Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | 4301112330 | MI |
N | 208000000X | Pediatrician | 110254 | FL |
N | 2080P0202X | Pediatric Cardiologist | 4301112330 | MI |
NPI | 1275882599 |
---|---|
Provider Name | Dr. Enrique Oliver Aregullin Eligio |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2012 |
Last Update Date | 16/04/2021 |