Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301064284 | MI |
N | 2080P0204X | Pediatric Emergency Doctor | 4301064284 | MI |
NPI | 1083654560 |
---|---|
Provider Name | Michelle Lynn Rivera |
First Address | Detroit, MI 48201-2153 |
Second Address | Detroit, MI 48201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 09/01/2017 |