Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 01078636A | IN |
N | 2086S0120X | Pediatric Surgery | 057466 | MI |
NPI | 1588664932 |
---|---|
Provider Name | Paul T. Stockmann |
First Address | Detroit, MI 48201 |
Second Address | Fort Wayne, IN 46845-1707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 23/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020H277290 | BLUE CROSS BLUE SHIELD MI (01) | MI |
1396817714 | GROUP NPI (01) | MI |
3289600 | (05) | MI |
329955410 | (05) | MI |
4115660 | (05) | MI |
700H262310 | BLUE CROSS-BLUE CROSS (01) | |
E45633 | (02) | |
PS057466 | CHAMPUS-CHAMPUS (01) | |
PS057466 | COMMERCIAL-COMMERCIAL NUMBER (01) |