Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 5101009273 | MI |
NPI | 1013924570 |
---|---|
Provider Name | Dr. Kimball W Silverton |
First Address | Flint, MI 48502-1611 |
Second Address | Grand Blanc, MI 48439-2443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 20/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0752501485 | BCBSM INDIVIDUAL PIN (01) | MI |
4069719 | (05) | MI |
B49216 | (02) | MI |