Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 4301061396 | MI |
N | 207RA0201X | Internist - Allergy & Immunology | 4301061396 | MI |
NPI | 1306837083 |
---|---|
Provider Name | Dr. Lee D Baylis |
First Address | Clarkston, MI 48346-2983 |
Second Address | Clarkston, MI 48346-2983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 20/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G76712 | (02) |