Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301053239 | MI |
NPI | 1003920323 |
---|---|
Provider Name | Mrs. Isabel B Holland-Davis |
First Address | West Bloomfield, MI 48322 |
Second Address | West Bloomfield, MI 48322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 19/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4254744 | (05) | MI |
F04665 | (02) |