Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301061827 | MI |
NPI | 1013025691 |
---|---|
Provider Name | Yolaine A Civil |
First Address | Ann Arbor, MI 48108 |
Second Address | Ypsilanti, MI 48198-5753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 06/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4764962 | (05) | MI |
G43865 | (02) | MI |