Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YP0228X | Pediatric Otolaryngology | MU012523 | MI |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MU012523 | MI |
NPI | 1083633911 |
---|---|
Provider Name | Mark Uzansky |
First Address | Livonia, MI 48154-5083 |
Second Address | Livonia, MI 48154-5083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 10/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4114467 | (05) | MI |
5820620 | BLUE CROSS BLUE SHIELD (01) | MI |
G91653 | (02) | MI |