Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 4301110735 | MI |
NPI | 1104813633 |
---|---|
Provider Name | Dr. Nishan Chobanian JR. |
First Address | Southfield, MI 48075-3707 |
Second Address | Saint Louis, MO 63141-8222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 03/01/2019 |