Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | YX068864 | MI |
N | 207ND0101X | MOHS-Micrographic Surgeon | YX068864 | MI |
N | 207ND0900X | Dermatopathologist | YX068864 | MI |
N | 207NP0225X | Pediatric Dermatologist | YX068864 | MI |
N | 207NS0135X | Procedural Dermatology | YX068864 | MI |
NPI | 1669421848 |
---|---|
Provider Name | Yuelin Xu |
First Address | Lansing, MI 48912-3753 |
Second Address | Lansing, MI 48912-3753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03 00013 | PHP (01) | MI |
4320447 | (05) | MI |
BX6271427 | DEA (01) | MI |
G83306 | (02) | MI |
YX068864 | STATE LICENSE (01) | MI |