Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 5101010657 | MI |
Y | 207PE0004X | Emergency Medical Services | 5101010657 | MI |
NPI | 1124001011 |
---|---|
Provider Name | Alan Janssen |
First Address | Palatine, IL 60055-0001 |
Second Address | Grand Blanc, MI 48439-8065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 06/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2923371 | (05) | MI |
3332882 | (05) | MI |
3332908 | (05) | MI |
AJ010657 | BLUE CROSS BLUE SHIELD (01) | |
E88318 | (02) |