Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 4301072565 | MI |
NPI | 1023004728 |
---|---|
Provider Name | Sophia Grias-Radwanski |
First Address | Southfield, MI 48034-1044 |
Second Address | Southfield, MI 48034-1044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 23/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H73391 | (02) | MI |