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 | 2085R0202X | Radiology | Diagnostic Radiology | | | 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 | 107851 | OTHER | MICHIGAN | CARE CHOICES |
| 2 | 29711 | OTHER | MICHIGAN | COMMUNITY CHOICE MI |
| 3 | RA820036 | OTHER | MICHIGAN | M-CARE |
| 4 | 0H27893 | OTHER | MICHIGAN | BLUE CARE NETWORK |
| 5 | 0H27893 | OTHER | MICHIGAN | BLUE CROSS BLUE SHIELD MI |
| 6 | 3S27618 | OTHER | MICHIGAN | HEALTHPLUS OF MI |
| 7 | 0H27893 | MEDICARE ID-TYPE UNSPECIFIED | MICHIGAN | |
| 8 | 26538 | OTHER | MICHIGAN | FEDERAL BLACK LUNG |
| 9 | 000000003836 | OTHER | MICHIGAN | CAPE HEALTH PLAN |
| 10 | CE4307 | OTHER | MICHIGAN | RAILROAD MEDICARE |
| 11 | 107851 | OTHER | MICHIGAN | PREFERRED CHOICES |
| 12 | 275144 | OTHER | MICHIGAN | FEDERAL BLACK LUNG |
| 13 | 2R27618 | OTHER | MICHIGAN | HEALTHPLUS OF MI |
| 14 | 7668 | OTHER | MICHIGAN | PRIORITY HEALTH |
| 15 | =========050 | OTHER | MICHIGAN | COMMUNITY CHOICE MI |
| 16 | O26194 | OTHER | MICHIGAN | HEALTH ALLIANCE PLAN |
| 17 | 008149 | OTHER | MICHIGAN | MIDWEST HEALTH PLAN |
