Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 4301066041 | MI |
NPI | 1114914835 |
---|---|
Provider Name | Todd Y Nida |
First Address | Southfield, MI 48034-1044 |
Second Address | Pontiac, MI 48341-5045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 08/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G13799 | (02) | MI |