Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | HM026513 | MI |
NPI | 1063489433 |
---|---|
Provider Name | Dr. Henry W. Maicki |
First Address | Farmington Hills, MI 48336-1917 |
Second Address | Farmington Hills, MI 48336-1917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0632414 | BLUE CARE NETWORK (01) | MI |
0632414 | BLUE CROSS BLUE SHIELD (01) | MI |
102619 | CARE CHOICES HMO (01) | MI |
102619 | PREFERRED CHOICES PPO (01) | MI |
148134 | GREAT LAKES HEALTH PLAN (01) | |
4359002 | (05) | MI |
4398521 | AETNA (01) | |
B44102 | (02) | |
C4990 | M CARE (01) | MI |