Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301095534 | MI |
Y | 2080P0214X | Pediatric Pulmonologist | 4301095534 | MI |
NPI | 1316272925 |
---|---|
Provider Name | Ruma Srivastava |
First Address | Detroit, MI 48201 |
Second Address | Detroit, MI 48201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2009 |
Last Update Date | 27/07/2019 |