Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 4301028752 | MI |
NPI | 1750309787 |
---|---|
Provider Name | Henry A Shevitz |
First Address | Southfield, MI 48075-2205 |
Second Address | Southfield, MI 48034-1330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 22/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
HS028752 | LICENSE (01) | MI |