Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 4351047261 | MI |
Y | 213ES0000X | Sports Medicine | 4351047261 | MI |
NPI | 1518333947 |
---|---|
Provider Name | Dr. Yusik Cho |
First Address | Bronx, NY 10463-6725 |
Second Address | Detroit, MI 48201-2018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2015 |
Last Update Date | 01/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
855O | WISCONSIN PHYSICIANS SERVICE (01) |