Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301037594 | MI |
Y | 111NI0900X | Internist | 4301037594 | MI |
N | 207RN0300X | Nephrologist | 4301037594 | MI |
NPI | 1023000783 |
---|---|
Provider Name | Jay Maurice Daitch |
First Address | Livonia, MI 48152-1412 |
Second Address | Livonia, MI 48152-1412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 27/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1335428 | (05) | MI |
A77413 | (02) | MI |