Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 4301060863 | MI |
NPI | 1164463600 |
---|---|
Provider Name | Rudolph P. Valentini |
First Address | Detroit, MI 48201-2153 |
Second Address | Detroit, MI 48201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 20/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
339919310 | (05) | MI |
700H262280 | BLUE CROSS-BLUE CROSS (01) | |
G38167 | (02) | |
RV060863 | CHAMPUS-CHAMPUS (01) | |
RV060863 | COMMERCIAL-COMMERCIAL NUMBER (01) |