Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | MH008745 | MI |
NPI | 1922030774 |
---|---|
Provider Name | Michael O Husmillo |
First Address | Birmingham, MI 48009-1779 |
Second Address | Flint, MI 48507-2919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 27/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0999791 | HEALTH PLUS (01) | MI |
4308993 | CIGNA (01) | MI |
950B51223-0 | BLUE CROSS OF MICHIGAN (01) | MI |
T32760 | (02) |