Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301071980 | MI |
N | 207PE0004X | Emergency Medical Services | 4301071980 | MI |
NPI | 1104863349 |
---|---|
Provider Name | Dr. Sarkis R Kouyoumjian |
First Address | Royal Oak, MI 48067-2173 |
Second Address | Detroit, MI 48201-2153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 18/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104308255 | (05) | MI |
104308264 | (05) | MI |
104308273 | (05) | MI |
104723899 | (05) | MI |
H41389 | (02) | MI |
SK071980 | BC/BS OF MICHIGAN (01) | MI |