Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301070662 | MI |
Y | 2080P0201X | Pediatric Allergist | 4301070662 | MI |
NPI | 1548207541 |
---|---|
Provider Name | Elizabeth Ann Secord |
First Address | Detroit, MI 48201-2153 |
Second Address | Detroit, MI 48201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 13/01/2017 |