Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 4301114075 | MI |
NPI | 1215293089 |
---|---|
Provider Name | Sheeba Joseph |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2012 |
Last Update Date | 04/06/2021 |