Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 009002 | MI |
NPI | 1861490856 |
---|---|
Provider Name | Dr. Gregory Varjabedian |
First Address | Novi, MI 48375-1878 |
Second Address | Novi, MI 48375-1878 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 15/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2591001 | (05) | MI |
E50171 | (02) | MI |