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 | 208800000X | Urology | | SP011304 | 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 | P63214 | OTHER | MICHIGAN | BLUE CARE NETWORK |
| 2 | 3405675 | MEDICAID | MICHIGAN | |
| 3 | 125257 | OTHER | MICHIGAN | CARE CHOICES HMO |
| 4 | 5270537 | OTHER | MICHIGAN | AETNA HMO |
| 5 | 5820491 | OTHER | MICHIGAN | BCBS PREFERRED PPO |
| 6 | C6514 | OTHER | MICHIGAN | M CARE HMO |
| 7 | 125257 | OTHER | MICHIGAN | PREFERRED CHOICES |
| 8 | 340015119 | OTHER | MICHIGAN | RAIL ROAD MEDICARE |
| 9 | 383369470 | OTHER | MICHIGAN | HARRINGTON/OSH CARE |
| 10 | 5270537 | OTHER | MICHIGAN | AETNA PPO |
| 11 | P63214 | OTHER | MICHIGAN | BLUE CHOICE |
| 12 | 5820491 | OTHER | MICHIGAN | BCBS REGULAR BUS |
| 13 | 5820491 | OTHER | MICHIGAN | BCBS COMMUNITY BLUE |
| 14 | 5820491 | OTHER | MICHIGAN | BCBS BLUE PREFERRED PLUS |
| 15 | G58858 | OTHER | MICHIGAN | HAP HMO |
| 16 | 004301068616 | OTHER | MICHIGAN | CAPE HMO |
| 17 | G58858 | OTHER | MICHIGAN | HAP PPO |
| 18 | G58858 | MEDICARE UPIN | MICHIGAN | |
| 19 | M50490001 | MEDICARE PIN | | |