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 | 207V00000X | Obstetrics & Gynecology | | 4301056913 | 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 | 1602513951 | OTHER | MICHIGAN | BLUE CARE NETWORK (BCN) BLUE CHOICE |
| 2 | 1606365292 | OTHER | MICHIGAN | HEALTH PLUS OF MICHIGAN (HGH) MEDICAID |
| 3 | 1602513951 | OTHER | MICHIGAN | BLUE CROSS BLUE SHIELD OF MICHIGAN PPO TRUST |
| 4 | 1606365292 | OTHER | MICHIGAN | HEALTH PLUS OF MICHIGAN MEDICARE |
| 5 | 1606365292 | OTHER | MICHIGAN | GENESEE HEALTH PLAN (GHP) |
| 6 | 15289 | OTHER | MICHIGAN | HEALTH PLAN OF MICHIGAN |
| 7 | 1602513951 | OTHER | MICHIGAN | BLUE CARE NETWORK (BCN) COMMERCIAL |
| 8 | 1602513951 | OTHER | MICHIGAN | BLUE CARE NETWORK (BCN) MEDICARE ADVANTAGE |
| 9 | F24353 | OTHER | MICHIGAN | HEALTH ALLIANCE PLAN (HAP) COMMERCIAL |
| 10 | 1606365292 | OTHER | MICHIGAN | HEALTH PLUS OF MICHIGAN COMMERCIAL |
| 11 | F24353 | OTHER | MICHIGAN | HEALTH ALLIANCE PLAN (HAP) PHP |
| 12 | 123042 | OTHER | MICHIGAN | PREFERRED CHOICES |
| 13 | 1366457848 | OTHER | MICHIGAN | MOLINA |
| 14 | 1602513951 | OTHER | MICHIGAN | BLUE CROSS BLUE SHIELD OF MICHIGAN ADVANTAGE |
| 15 | 1606365292 | OTHER | MICHIGAN | HEALTH PLUS OF MICHIGAN PPO |
| 16 | 1602513951 | OTHER | MICHIGAN | BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL |
| 17 | 1602513951 | OTHER | MICHIGAN | BLUE CARE NETWORK (BCN) BLUE PREFERRED PLUS |
