Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 5101013110 | MI |
Y | 207PE0004X | Emergency Medical Services | 5101013110 | MI |
NPI | 1174506190 |
---|---|
Provider Name | Dr. Michael Nithiphaisal Yu |
First Address | Palatine, IL 60055-7767 |
Second Address | Grand Blanc, MI 48439-8065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 09/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4253175 | (05) | MI |
4253184 | (05) | MI |
4253193 | (05) | MI |
930109721 | RAILROAD MEDICARE (01) | |
H44582 | (02) | MI |
MY013110 | BLUE CROSS BLUE SHIELD (01) |