Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 5101009680 | MI |
NPI | 1053356899 |
---|---|
Provider Name | Susan J Knoll-Vlachos |
First Address | Southfield, MI 48033-3849 |
Second Address | Farmington Hills, MI 48336-5966 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 11/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F38758 | (02) |