Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 4301048384 | MI |
NPI | 1134485139 |
---|---|
Provider Name | Dr. James Austin Womack |
First Address | Detroit, MI 48221 |
Second Address | Detroit, MI 48221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2012 |
Last Update Date | 04/04/2012 |