Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 4301034927 | MI |
NPI | 1124012943 |
---|---|
Provider Name | Muthayipalayam C Thirumoorthi |
First Address | Clinton Twp, MI 48038-1136 |
Second Address | Detroit, MI 48236-2169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 19/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1266139 | ECFMG (01) | |
1880500 | (05) | MI |
4301034927 | CONTROLLED SUBSTANCE (01) | |
A78428 | (02) |