Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301106009 | MI |
N | 207RC0200X | Critical Care Medicine | 4301106009 | MI |
NPI | 1023307204 |
---|---|
Provider Name | Ivan Nathaniel Co |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2011 |
Last Update Date | 27/01/2020 |