Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 108179 | MO |
N | 2080P0202X | Pediatric Cardiologist | 108179 | MO |
Y | 2080P0202X | Pediatric Cardiologist | 4301503589 | MI |
NPI | 1245258920 |
---|---|
Provider Name | Dr. Gautam K Singh |
First Address | Detroit, MI 48202-2608 |
Second Address | Detroit, MI 48202-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245258920 | (05) | MI |
208027409 | (05) | MO |
ENROLLED | (05) | IL |