Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5101017814 | MI |
NPI | 1225284763 |
---|---|
Provider Name | Adam Rourke |
First Address | Sterling Heights, MI 48314-1511 |
Second Address | Sterling Heights, MI 48314-1511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2008 |
Last Update Date | 11/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
700F399670 | BCBSM GROUP PIN (01) | MI |