Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 7601000059 | MI |
NPI | 1184260754 |
---|---|
Provider Name | Kelly Jo Aguilera |
First Address | Freeland, MI 48623-9436 |
Second Address | Freeland, MI 48623-9436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2019 |
Last Update Date | 19/11/2019 |