Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 5101009519 | MI |
NPI | 1124095278 |
---|---|
Provider Name | Todd A Moyer-Brailean |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48823-5353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0700054 | PHP PROVIDER # (01) | MI |
0770054 | PHP FAMILYCARE PROVIDER# (01) | MI |
1011190 | MCLAREN PROVIDER # (01) | MI |
160045101 | RR MEDICARE PROVIDER # (01) | MI |
3418824 | (05) | MI |
5331613 | BCBS/BCN PROVIDER # (01) | MI |
E88314 | (02) | MI |