Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 4301049182 | MI |
NPI | 1023186830 |
---|---|
Provider Name | Elizabeth J. Angus |
First Address | Detroit, MI 48202 |
Second Address | Detroit, MI 48202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B48632 | (02) | |
EA049182 | CHAMPUS-CHAMPUS (01) | |
EA049182 | COMMERCIAL-COMMERCIAL NUMBER (01) |