Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 31895 | MI |
NPI | 1073524245 |
---|---|
Provider Name | Dr. Satyabrata Maitra |
First Address | Bloomfield Hills, MI 48302-2926 |
Second Address | Detroit, MI 48201-1916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31895 | STAFF PHYSICIAN (01) | MI |