Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101018245 | MI |
NPI | 1851720312 |
---|---|
Provider Name | Dr. Prasad J Thottam |
First Address | West Bloomfield, MI 48322-3607 |
Second Address | West Bloomfield, MI 48322-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2013 |
Last Update Date | 31/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
383490114 | TAX ID (01) | MI |