Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4301043557 | MI |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 4301043557 | MI |
NPI | 1194818302 |
---|---|
Provider Name | John O De Lancey |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-4276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 10/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1368287 | (05) | MI |
B49339 | (02) | MI |