Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 4301406824 | MI |
NPI | 1336147461 |
---|---|
Provider Name | Joseph Lawrence Lelli |
First Address | Detroit, MI 48202 |
Second Address | Detroit, MI 48202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 17/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1396817714 | GROUP NPI (01) | MI |
4446233 | (05) | MI |
4446260 | (05) | MI |
4625708 | (05) | MI |
E77335 | (02) | MI |