Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 4301043390 | MI |
NPI | 1063406635 |
---|---|
Provider Name | Renato S Casabar |
First Address | Clinton Twp, MI 48038-1136 |
Second Address | Detroit, MI 48236-2169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1555092 | (05) | MI |
B49045 | (02) |