Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301074624 | MI |
Y | 111NI0900X | Internist | 4301074624 | MI |
N | 207RH0002X | Hospice and Palliative Medicine | 4301074624 | MI |
NPI | 1073656963 |
---|---|
Provider Name | Mirjana Stancic |
First Address | Kalamazoo, MI 49009-3016 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 12/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H67825 | (02) |