Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301066654 | MI |
N | 208600000X | Surgeon | 4301066654 | MI |
N | 2086S0120X | Pediatric Surgery | 4301066654 | MI |
NPI | 1164524492 |
---|---|
Provider Name | Eustace S Golladay |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-0245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3214332 | (05) | MI |
B90228 | (02) | MI |