Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 4556 | OK |
NPI | 1073507422 |
---|---|
Provider Name | Dr. Kirby Douglas Slifer |
First Address | Detroit, MI 48278-1076 |
Second Address | Michigan City, IN 46360-4358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 26/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073507422 | (05) | IN |
200116690A | (05) | OK |
D14789 | (02) | IN |
P00664346 | MEDICARE RAILROAD (01) | IN |