Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 4301084298 | MI |
NPI | 1568687135 |
---|---|
Provider Name | Irena Zmitrovic |
First Address | Livonia, MI 48154-5010 |
Second Address | Livonia, MI 48154-5010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 11/07/2011 |