Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 4301032827 | MI |
NPI | 1124089305 |
---|---|
Provider Name | John Musich |
First Address | Royal Oak, MI 48073-6712 |
Second Address | Royal Oak, MI 48073-6710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1356052 | (05) | MI |
1606301230 | BCBSM (01) | MI |
B47333 | (02) | MI |