Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 4301032759 | MI |
NPI | 1063506335 |
---|---|
Provider Name | Susumu Inoue |
First Address | Flint, MI 48503-5902 |
Second Address | Flint, MI 48503-5902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 26/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3512517601 | BLUECROSS BLUE SHIELD # (01) | MI |