Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 5101011078 | MI |
NPI | 1003865874 |
---|---|
Provider Name | Dr. Mimi Chen |
First Address | Warren, MI 48088-4330 |
Second Address | Warren, MI 48088-4330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 31/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4178357 | (05) | MI |
4178366 | (05) | MI |
G14662 | (02) | MI |