Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 5101010352 | MI |
NPI | 1124018213 |
---|---|
Provider Name | Michael S Haupert |
First Address | West Bloomfield, MI 48322-3604 |
Second Address | West Bloomfield, MI 48322-3604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 09/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040E011990 | BCBS OF MI (01) | MI |
4189280 | (05) | MI |
4189299 | (05) | MI |
4189305 | (05) | MI |
4606981 | (05) | MI |
F42236 | (02) | MI |