Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5101010694 | MI |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 5101010694 | MI |
NPI | 1083611560 |
---|---|
Provider Name | Dr. Keith M Tobin |
First Address | Livonia, MI 48150-2335 |
Second Address | Livonia, MI 48150-2335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4082200 | (05) | MI |
5101010694 | STATE LICENSE NUMBER (01) | MI |
5820442 | BCBS PROVIDER ID (01) | MI |
993699 | AETNA PROVIDER ID (01) | MI |
C4002 | MCARE PROVIDER ID (01) | MI |
F05096 | (02) | MI |
F05096 | HAP PROVIDER ID (01) | MI |
P86747 | BCN PROVIDER ID (01) | MI |