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 | |
|---|---|---|
| * | Adolescent Medicine | 207QA0000X |
| Clinical | 1041C0700X |
* Indicates primary specialty
| NPI Number | 1841079787 |
| Legal business name LBN |
SPARROW EATON HOSPITAL |
| Authorized official | MISTY RUSSIAN - (SUPERVISOR, PROVIDER ENROLLMENT) |
| Entity | Organization |
| Organization subpart | Yes |
| Enumeration date | 09/28/2023 |
| Last updated | 11/08/2024 - More than a year ago |
| Sole proprietor1 | Not specified |
| Identifiers | n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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