Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | RS006448 | MI |
NPI | 1497715072 |
---|---|
Provider Name | Dr. Richard K Stoler |
First Address | Livonia, MI 48154-5083 |
Second Address | Livonia, MI 48154-5083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 20/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0458216354 | BLUE CROSS BLUE SHIELD MI (01) | MI |
E68169 | (02) | MI |