Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 4301055494 | MI |
NPI | 1508835356 |
---|---|
Provider Name | Thomas E. Flynn |
First Address | Kalamazoo, MI 49008-1282 |
Second Address | Kalamazoo, MI 49008-1282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 04/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0C97618 | BCBSM (01) | MI |
1508835356 | (05) | MI |
4183301 | (05) | MI |
4403904071 | BCBS (01) | |
F60030 | (02) |