Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301086375 | MI |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 4301086375 | MI |
N | 207R00000X | Internist | 4301086375 | MI |
N | 111NI0900X | Internist | 4301086375 | MI |
Y | 207RG0300X | Geriatric Medicine | 4301086375 | MI |
NPI | 1215120738 |
---|---|
Provider Name | Erin Michelle Diviney Chun |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 24/05/2019 |