Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301054295 | MI |
NPI | 1073600243 |
---|---|
Provider Name | Susan L Garetz |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 09/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3226567 | (05) | MI |
G22929 | (02) | MI |