Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301048977 | MI |
N | 111NI0900X | Internist | 4301048977 | MI |
Y | 207RH0000X | Hematologist | 4301048977 | MI |
NPI | 1366528325 |
---|---|
Provider Name | Paula L Bockenstedt |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 24/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1676454 | (05) | MI |
B47978 | (02) | MI |