Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
1 | 204C00000X | Neuromusculoskeletal Medicine, Sports Medicine | | 4301069245 | MICHIGAN | No |
2 | 204C00000X | Neuromusculoskeletal Medicine, Sports Medicine | | 01059980A | INDIANA | No |
3 | 207P00000X | Emergency Medicine | | 4301069245 | MICHIGAN | No |
4 | 207RG0300X | Internal Medicine | Geriatric Medicine | 4301069245 | MICHIGAN | No |
5 | 207RG0300X | Internal Medicine | Geriatric Medicine | 01059980A | INDIANA | Yes |
6 | 2083X0100X | Preventive Medicine | Occupational Medicine | 4301069245 | MICHIGAN | No |
7 | 2083X0100X | Preventive Medicine | Occupational Medicine | 01059980A | INDIANA | No |
8 | 202C00000X | Independent Medical Examiner | | 4301069245 | MICHIGAN | No |
9 | 202C00000X | Independent Medical Examiner | | 01059980A | INDIANA | No |