Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | SR007473 | MI |
NPI | 1013988278 |
---|---|
Provider Name | Stanley Szumiak Roland |
First Address | Lapeer, MI 48446 |
Second Address | Lapeer, MI 48446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 28/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0754400304 | BLUE CROSS BLUE SHIELD (01) | MI |
E26765 | (02) |