Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 5101013192 | MI |
NPI | 1063469278 |
---|---|
Provider Name | Dr. Nirmal Nandakumar |
First Address | West Bloomfield, MI 48323-2096 |
Second Address | Southfield, MI 48075-4818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114327279 | (05) | MI |
114327288 | (05) | MI |
114327297 | (05) | MI |
H32900 | (02) | MI |
NN013192 | BC/BS OF MICHIGAN (01) | MA |