Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC8263 | TX |
N | 111NN0400X | Neurology | 2301009328 | MI |
Y | 363L00000X | Nurse Practitioner | 4704287416 | MI |
NPI | 1497708200 |
---|---|
Provider Name | John Pispidikis |
First Address | Warren, MI 48092-5644 |
Second Address | Warren, MI 48092-5644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 07/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002102403 | (05) | TX |
8M8882 | BCBS (01) | TX |
8P2242 | BCBS (01) | TX |
8P5600 | BCBS (01) | TX |
8R1720 | BCBS (01) | TX |
U76018 | (02) | MI |