Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 4301077893 | MI |
NPI | 1063579415 |
---|---|
Provider Name | Dr. Jacalyn Meredith Bishop |
First Address | Novi, MI 48375-1878 |
Second Address | Novi, MI 48375-1878 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 17/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
519615310 | (05) | MI |