Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301095358 | MI |
N | 2080P0205X | Pediatric Endocrinologist | 01036925 | IN |
Y | 2080P0205X | Pediatric Endocrinologist | 4301095358 | MI |
NPI | 1487760914 |
---|---|
Provider Name | Ora Hirsch Pescovitz |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-4259 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 26/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100068690 | (05) | IN |
C24391 | (02) | |
C24391 | (02) | MI |