Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4301056978 | MI |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 4301056978 | MI |
NPI | 1295720001 |
---|---|
Provider Name | Shyla R Vengalil |
First Address | Grosse Pointe Woods, MI 48236-2167 |
Second Address | Detroit, MI 48236-2167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 16/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4408530 | ECFMG (01) | |
G15399 | (02) |