Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 4301063353 | MI |
N | 225400000X | Rehabilitation Practitioner | JS063353 | MI |
NPI | 1053351247 |
---|---|
Provider Name | Dr. James Stathakios JR. |
First Address | Flint, MI 48507-3042 |
Second Address | Flint, MI 48507-3042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 12/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103517420 | (05) | MI |