Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301066261 | MI |
NPI | 1003886342 |
---|---|
Provider Name | Jefferey E Michaelson |
First Address | Phoenix, AZ 85023-1261 |
Second Address | Southfield, MI 48075-4825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 17/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4337650 | (05) | MI |
G90456 | (02) | MI |