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A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Adolescent Medicine |
207QA0000X | 08 | Physician/Family Practice | |
Clinic/Center |
261Q00000X | |||
Internal Medicine |
207R00000X | 11 | Physician/Internal Medicine | |
Pain Medicine |
207LP2900X | 05 | Physician/Anesthesiology | |
Pain Medicine |
2081P2900X | 25 | Physician/Physical Medicine and Rehabilitation | |
Pediatrics |
208000000X | 37 | Physician/Pediatric Medicine |
| NPI # | 1760681159 |
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| LBN Legal business name | SPARROW EATON HOSPITAL | ||||
| Authorized official | MISTY RUSSIAN - (SUPERVISOR, PROVIDER ENROLLMENT) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | Yes | ||||
| Enumeration date | 07/16/2007 | ||||
| Last updated | 03/18/2024 - About 2 years ago | ||||
| Identifiers |
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SPARROW EATON HOSPITAL
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SPARROW EATON HOSPITAL