Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101021568 | MI |
NPI | 1003297243 |
---|---|
Provider Name | Satya Pillay |
First Address | Traverse City, MI 49684-7823 |
Second Address | Traverse City, MI 49684-7823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2015 |
Last Update Date | 28/12/2020 |