Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301077495 | MI |
N | 207QS0010X | Family Doctor - Sports Medicine | 4301077495 | MI |
NPI | 1124194592 |
---|---|
Provider Name | Melissa Nayak |
First Address | Detroit, MI 48202 |
Second Address | Detroit, MI 48202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I44606 | (02) | |
MN077495 | CHAMPUS-CHAMPUS (01) | |
MN077495 | COMMERCIAL-COMMERCIAL NUMBER (01) |