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 | 363A00000X | Physician Assistant | | 5601004391 | 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 | 1023384 BRIDGEPORT | OTHER | MICHIGAN | MCLAREN HEALTH PLAN |
| 2 | 1022871 RUFFIN | OTHER | MICHIGAN | MCLAREN HEALTH PLAN |
| 3 | Q34896 | MEDICARE UPIN | MICHIGAN | |
| 4 | 4549956 | OTHER | MICHIGAN | MOLINA HEALTH CARE OF MI |
| 5 | 381908328-368 | OTHER | MICHIGAN | COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE |
| 6 | 381908328-371 | OTHER | MICHIGAN | COMMUNITY CHOICE MICHIGAN/CARE SOURCE |
| 7 | 381908328-372 | OTHER | MICHIGAN | COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE |
| 8 | 0M93030012 | MEDICARE PIN | MICHIGAN | |
| 9 | 381908328-373 | OTHER | MICHIGAN | COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE |
| 10 | 381908328 | OTHER | MICHIGAN | PRIORITY HEALTH OF MICHIGAN |
| 11 | 381908328-370 | OTHER | MICHIGAN | COMMUNITY CHOICE/CARE SOURCE |
| 12 | 0G36111078 | MEDICARE PIN | | |
| 13 | 1022873 DRG | OTHER | MICHIGAN | MCLAREN HEALTH PLAN |
| 14 | 381908328-367 | OTHER | MICHIGAN | COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE |
| 15 | 381908328-369 | OTHER | MICHIGAN | COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE |
| 16 | 381908328-366 | OTHER | MICHIGAN | COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE |
| 17 | 1022872 MONITOR | OTHER | MICHIGAN | MCLAREN HEALTH PLAN |
| 18 | 1022696 JANES ST. | OTHER | MICHIGAN | MCLAREN HEALTH PLAN |
| 19 | 159123 | OTHER | MICHIGAN | GREAT LAKES HEALTH PLAN |