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 | 390200000X | Student in an Organized Health Care Education/Training Program | | RS2012-0788 | NEW MEXICO | No |
| 2 | 207RE0101X | Internal Medicine | Endocrinology, Diabetes & Metabolism | SK078965 | 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 | 024544 | OTHER | MICHIGAN | MIDWEST HEALTH PLAN |
| 2 | 0P23930 | OTHER | MICHIGAN | MICHIGAN MEDICARE PLUS BL |
| 3 | 562533142 | OTHER | MICHIGAN | MICHIGAN TAX ID |
| 4 | 6U4933 | OTHER | MICHIGAN | HEALTH ALLIANCE PLAN HMO |
| 5 | 562533142 | OTHER | MICHIGAN | HARVARD PILGRIM NATIONAL |
| 6 | 562533142 | OTHER | MICHIGAN | CHAMPUS TRICARE |
| 7 | 562533142 | OTHER | MICHIGAN | CIGNA HEALTH PLANS |
| 8 | RS2012-0788 | OTHER | NEW MEXICO | LICENSE NUMBER |
| 9 | 142240 | OTHER | MICHIGAN | PREFERRED CHOICES |
| 10 | 17388 | OTHER | MICHIGAN | M-CARE HMO |
| 11 | 142240 | OTHER | MICHIGAN | CARE CHOICES PIN |
| 12 | E37337 | MEDICARE UPIN | MICHIGAN | |
| 13 | 0P23930 | MEDICARE PIN | MICHIGAN | |
| 14 | 1108140971 | OTHER | MICHIGAN | BCBS OF MICHIGAN PIN |
| 15 | 562533142 | OTHER | MICHIGAN | UNITED HEALTH CARE PLANS |
| 16 | A4238872 | OTHER | MICHIGAN | AETNA PLANS |
| 17 | 562533142 | OTHER | MICHIGAN | PPOM |
| 18 | SK078965 | OTHER | MICHIGAN | MICHIGAN STATE LICENSE |
| 19 | 104932923 | MEDICAID | MICHIGAN | |
| 20 | 562533142 | OTHER | MICHIGAN | WASHTENAW HEALTH PLAN |
