Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 4301405374 | MI |
NPI | 1013998731 |
---|---|
Provider Name | Robert K Welsh |
First Address | Southfield, MI 48033-3849 |
Second Address | Royal Oak, MI 48073-6710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103360635 | (05) | MI |
294552010 | (05) | MI |
330F373770 | BLUE CROSS BLUE SHIELD (01) | MI |
F54702 | (02) |