Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 5101008748 | MI |
NPI | 1235121138 |
---|---|
Provider Name | Steven T Plomaritis |
First Address | Warren, MI 48088-4396 |
Second Address | Warren, MI 48088-4396 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 23/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3013165 | (05) | MI |
E26760 | (02) | |
SP008748 | BCBS PIN # (01) | MI |