Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301059400 | MI |
N | 207PE0004X | Emergency Medical Services | 4301059400 | MI |
NPI | 1033208558 |
---|---|
Provider Name | Dr. Pino D. Colone |
First Address | Detroit, MI 48202-3450 |
Second Address | Detroit, MI 48202-3450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 31/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0B51090 | BLUE SHIELD (01) | MI |
3427500 | (05) | MI |
F99437 | (02) | MI |