Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | SP064843 | MI |
NPI | 1013949650 |
---|---|
Provider Name | Dr. Steven Owen Podolsky |
First Address | Mt Pleasant, MI 48858-3256 |
Second Address | Mt Pleasant, MI 48858-3256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 17/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104353850 | (05) | MI |
160C71016 | BCBS GROUP# (01) | MI |
F56197 | (02) | MI |