Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301057563 | MI |
NPI | 1023079415 |
---|---|
Provider Name | Dr. Patricia A Wilkerson-Uddyback |
First Address | Detroit, MI 48203-1479 |
Second Address | Detroit, MI 48201-2153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F93078 | (02) | MI |
PW057563 | BC/BS OF MI (01) | MI |