Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 4301031487 | MI |
NPI | 1003184748 |
---|---|
Provider Name | Khachorndej Vibhasiri |
First Address | Bloomfield Hills, MI 48304-1900 |
Second Address | Bloomfield Hills, MI 48304-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2011 |
Last Update Date | 08/12/2011 |