Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301062469 | MI |
N | 207PE0004X | Emergency Medical Services | 4301062469 | MI |
NPI | 1215026042 |
---|---|
Provider Name | Dr. Marcia A. Perry |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 29/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0B51090 | BLUE SHIELD (01) | MI |
3367396 | (05) | MI |
3423163 | (05) | MI |
G19328 | (02) | MI |