Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301109305 | MI |
NPI | 1003159583 |
---|---|
Provider Name | Lindsey Nicole Farah-Brunner |
First Address | Detroit, MI 48201-2153 |
Second Address | Detroit, MI 48201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2013 |
Last Update Date | 17/03/2018 |