Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | G45397 | CA |
NPI | 1215004023 |
---|---|
Provider Name | Michael A. Sue |
First Address | Panorama City, CA 91402-5423 |
Second Address | Panorama City, CA 91402-5423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 23/09/2008 |