Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301100887 | MI |
N | 2080P0204X | Pediatric Emergency Doctor | 4301100887 | MI |
NPI | 1124383286 |
---|---|
Provider Name | Jason Michael King |
First Address | Detroit, MI 48201 |
Second Address | Detroit, MI 48201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 17/01/2018 |