Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301071894 | MI |
Y | 111NI0900X | Internist | 4301071894 | MI |
N | 207RH0002X | Hospice and Palliative Medicine | 4301071894 | MI |
NPI | 1164523247 |
---|---|
Provider Name | Sonali Nitin Wilborn |
First Address | Dearborn, MI 48120-1802 |
Second Address | Dearborn, MI 48124-5032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 22/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1108294772 | BCBS (01) | MI |
110H243080 | BCBSM (01) | MI |
1427297712 | (05) | MI |
4535861-10 | (05) | MI |
H48635 | (02) | MI |