Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 4301046743 | MI |
NPI | 1275604407 |
---|---|
Provider Name | I. Zachary Dyme |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48824-7040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 04/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101559420 | (05) | MI |
1275604407 | (05) | MI |
3503311161 | BCBS OF MICHIGAN (01) | MI |
B44975 | (02) | MI |