Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 4301108613 | MI |
N | 207U00000X | Nuclear Medicine Specialist | 23863 | NE |
NPI | 1700010063 |
---|---|
Provider Name | Mr. Shrinivas Bishu |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2009 |
Last Update Date | 16/09/2015 |