Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | SY038909 | MI |
Y | 207RP1001X | Pulmonary Disease | SY038909 | MI |
NPI | 1023126448 |
---|---|
Provider Name | Dr. Subramanyam Yadam |
First Address | Midland, MI 48640 |
Second Address | Midland, MI 48640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 02/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2120984 | (05) | MI |
2905610541 | BLUE CROSS BLUE SHIELD (01) | MI |
A76207 | (02) |