Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 5901001825 | MI |
NPI | 1356331441 |
---|---|
Provider Name | Ellen Mady |
First Address | West Bloomfield, MI 48323-2184 |
Second Address | West Bloomfield, MI 48323-2184 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 14/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U65107 | (02) | MI |