Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901010473 | MI |
N | 1223P0700X | Prosthodontist | 2901010473 | MI |
NPI | 1023132172 |
---|---|
Provider Name | Michael E Razzoog |
First Address | Ann Arbor, MI 48109-1078 |
Second Address | Ann Arbor, MI 48109-1078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1958160410 | BCBS OF MI MED SURGICAL (01) | MI |
D104730 | BCBS OF MI DENTAL (01) | MI |