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 | 207P00000X | Emergency Medicine | | | | No |
| 2 | 207RC0000X | Internal Medicine | Cardiovascular Disease | | | No |
| 3 | 207RH0005X | Internal Medicine | Hypertension Specialist | | | No |
| 4 | 207RN0300X | Internal Medicine | Nephrology | | | No |
| 5 | 207T00000X | Neurological Surgery | | | | No |
| 6 | 251E00000X | Home Health | | | | No |
| 7 | 251G00000X | Hospice Care, Community Based | | | MICHIGAN | No |
| 8 | 261QC1800X | Clinic/Center | Corporate Health | | MICHIGAN | No |
| 9 | 261QE0700X | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment | | | No |
| 10 | 261QH0100X | Clinic/Center | Health Service | | MICHIGAN | Yes |
| 11 | 261QI0500X | Clinic/Center | Infusion Therapy | | MICHIGAN | No |
| 12 | 305S00000X | Point of Service | | | | No |
| 13 | 3336H0001X | Pharmacy | Home Infusion Therapy Pharmacy | | | No |
| 14 | 343800000X | Secured Medical Transport (VAN) | | | | No |
| 15 | 385HR2050X | Respite Care | Respite Care Camp | | | No |
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 | 1710240403 | MEDICAID | PENNSYLVANIA | |
