Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301062812 | MI |
N | 111NI0900X | Internist | 4301062812 | MI |
N | 207RH0000X | Hematologist | 4301062812 | MI |
NPI | 1386722015 |
---|---|
Provider Name | Lilli M Petruzzelli |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-0912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3010074 | (05) | MI |
F56924 | (02) | MI |