Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 4301085240 | MI |
NPI | 1306047717 |
---|---|
Provider Name | Janardhan Rao Jagini |
First Address | Southfield, MI 48034-1105 |
Second Address | Detroit, MI 48201-2119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 16/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040E011990 | BCBS OF MI (01) | MI |
519222510 | (05) | MI |
519253910 | (05) | MI |
519559510 | (05) | MI |