Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 4301033903 | MI |
NPI | 1093875536 |
---|---|
Provider Name | Subbana G Muthuswami |
First Address | Port Huron, MI 48060 |
Second Address | Port Huron, MI 48060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2109010 | (05) | MI |
A73999 | (02) |