Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 5101005730 | MI |
NPI | 1245230036 |
---|---|
Provider Name | Robert S Barbosa |
First Address | Detroit, MI 48267-0001 |
Second Address | Warren, MI 48093-2572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 30/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3192039 | (05) | MI |
C98133 | (02) | |
RB005730 | BCBS PIN # (01) | MI |