Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 4301030886 | MI |
NPI | 1740233105 |
---|---|
Provider Name | Dr. John E Freitas |
First Address | Ypsilanti, MI 48197-1014 |
Second Address | Ypsilanti, MI 48197-1014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 30/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2857015 | (05) | MI |
B44339 | (02) | MI |