Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 098965 | OH |
N | 2080P0205X | Pediatric Endocrinologist | 23711 | MS |
Y | 2080P0205X | Pediatric Endocrinologist | 4301114264 | MI |
NPI | 1497986731 |
---|---|
Provider Name | Ethel Gonzales Clemente |
First Address | Kalamazoo, MI 49008-1282 |
Second Address | Kalamazoo, MI 49008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2009 |
Last Update Date | 16/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02327355 | (05) | MS |