Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301079262 | MI |
NPI | 1124075767 |
---|---|
Provider Name | Dr. Sharon Bajwa |
First Address | Royal Oak, MI 48068-0100 |
Second Address | Southfield, MI 48075-4818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 22/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104410769 | (05) | MI |
104432837 | (05) | MI |
H66439 | (02) | MI |
SB079262 | BC/BS OF MICHIGAN (01) | MI |