Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301082232 | MI |
NPI | 1134140239 |
---|---|
Provider Name | Dr. Melisa Gagrica |
First Address | Ferndale, MI 48220-3420 |
Second Address | Detroit, MI 48201-2153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 17/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036118494 | (05) | IL |
I65846 | (02) |