Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301405689 | MI |
N | 111NI0900X | Internist | 4301405689 | MI |
Y | 207RG0300X | Geriatric Medicine | 4301405689 | MI |
N | 207RH0002X | Hospice and Palliative Medicine | 4301405689 | MI |
NPI | 1033291083 |
---|---|
Provider Name | Neal Wayne Persky |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-2700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 02/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E37456 | (02) | MI |