Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301070615 | MI |
NPI | 1013925494 |
---|---|
Provider Name | Troy Sibson |
First Address | Hartland, MI 48353-2702 |
Second Address | Hartland, MI 48353-2702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 13/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
700H228210 | BCBSM/BCN (01) | MI |
P35120185 | (02) | MI |