Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 01079577A | IN |
Y | 207K00000X | Allergist & Immunologist | 4301074135 | MI |
NPI | 1063416642 |
---|---|
Provider Name | Dr. Sutinderpal S. Judge |
First Address | Saint Joseph, MI 49085-3270 |
Second Address | Saint Joseph, MI 49085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 12/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4650649 | (05) | MI |
Y12563 | (02) | MI |