Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301088040 | MI |
Y | 2080P0210X | Pediatric Nephrologist | 4301088040 | MI |
NPI | 1518175488 |
---|---|
Provider Name | Dr. Rossana Baracco Maggi |
First Address | Detroit, MI 48201 |
Second Address | Detroit, MI 48201-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 02/10/2012 |