Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 4301405802 | MI |
NPI | 1235136599 |
---|---|
Provider Name | William B Blessed |
First Address | Southfield, MI 48075-4826 |
Second Address | Southfield, MI 48075-3712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 09/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
285429210 | (05) | MI |
F00469 | (02) | MI |