Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501008544 | MI |
NPI | 1003011131 |
---|---|
Provider Name | Mr. Vishal Doshi |
First Address | Bloomfield Hills, MI 48302-0836 |
Second Address | Bloomfield Hills, MI 48302-0836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 18/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0F35868 | BLUE CROSS BLUE SHIELD (01) | MI |