Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301099104 | MI |
N | 207PP0204X | Pediatric Emergency Physician | 4301099104 | MI |
N | 208000000X | Pediatrician | 4301099104 | MI |
NPI | 1487941241 |
---|---|
Provider Name | Emily Joan Mathias |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-4205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2011 |
Last Update Date | 20/09/2017 |