Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101020312 | MI |
N | 207R00000X | Internist | 5101020312 | MI |
N | 111NI0900X | Internist | 5101020312 | MI |
NPI | 1366888448 |
---|---|
Provider Name | Mindy Chilman Mccomb |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48823-6804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2013 |
Last Update Date | 07/06/2021 |