Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | JS005955 | MI |
NPI | 1164430260 |
---|---|
Provider Name | Dr. John David Sellers |
First Address | Novi, MI 48375-1845 |
Second Address | Novi, MI 48375-1845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 16/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1656316504 | BLUECROSS BLUE SHIELD (01) | MI |