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 | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | | 4301069411 | MICHIGAN | No |
| 2 | 208D00000X | General Practice | | 4301069411 | MICHIGAN | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1018867 | OTHER | MICHIGAN | HEALTH ADVANTAGE NETWORK |
| 2 | 4840124 | MEDICAID | MICHIGAN | |
| 3 | 330C313780 | OTHER | MICHIGAN | BLUE CROSS TRADITIONAL |
| 4 | 1018867 | OTHER | MICHIGAN | MCLAREN HEALTH PLAN |
| 5 | 330C313780 | OTHER | MICHIGAN | BLUE CARE NETWORK |
| 6 | 330C313780 | OTHER | MICHIGAN | BLUE CHOICE |
| 7 | 300C313780 | OTHER | MICHIGAN | BLUE CROSS COMMUNITY BLUE |
| 8 | 330C313780 | OTHER | MICHIGAN | BLUE PREFERRED PLUS |
| 9 | 1800008 | OTHER | MICHIGAN | PHYSICIANS HEALTH PLAN |
| 10 | B18332 | OTHER | MICHIGAN | HEALTH NET |
