Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 4301100788 | MI |
NPI | 1023244126 |
---|---|
Provider Name | Ismael Enrique Gonzalez Rangel |
First Address | Southfield, MI 48033-3849 |
Second Address | Royal Oak, MI 48073-6770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2009 |
Last Update Date | 22/10/2020 |