Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2006-00286 | NC |
N | 208000000X | Pediatrician | 4301089314 | MI |
Y | 2080P0202X | Pediatric Cardiologist | 4301089314 | MI |
N | 2080P0203X | Pediatric Critical Care Doctor | 4301089314 | MI |
NPI | 1265460141 |
---|---|
Provider Name | Jimmy Chamtsum Lu |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 16/04/2010 |