Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 4301070065 | MI |
NPI | 1023012481 |
---|---|
Provider Name | Dr. Laura J Piippo |
First Address | Grand Rapids, MI 49525-6049 |
Second Address | Grand Rapids, MI 49525-6049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 09/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
180046322 | MEDICARE RR (01) | MI |
4502350 | (05) | MI |
H75971 | (02) |