Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | S123766016851 | MI |
NPI | 1912374281 |
---|---|
Provider Name | Siphay Sipaseuth |
First Address | Belleville, MI 48111-3170 |
Second Address | Belleville, MI 48111-3170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2015 |
Last Update Date | 21/08/2015 |