Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 5101011132 | MI |
NPI | 1063447373 |
---|---|
Provider Name | Madeline Turner |
First Address | Lake Orion, MI 48360 |
Second Address | Lake Orion, MI 48360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0756300995 | BCBS (01) | MI |
3182186 | (05) | MI |
G14204 | (02) |