Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 4301032840 | MI |
NPI | 1790726107 |
---|---|
Provider Name | Prof. Michael K. Lala |
First Address | Clinton Township, MI 48035-3274 |
Second Address | Clinton Township, MI 48035-3274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 25/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0Q26008 | BCBS PROVIDER NUMBER (01) | MI |
0Q26008 | BLUE CARE NETWORK (01) | MI |
1006439 | MCCLAREN HEALTH (01) | |
4894742 | (05) | MI |
B46453 | (02) | MI |
P00343263 | RR MEDICARE (01) |