Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 4301061751 | MI |
N | 2086S0122X | Plastic and Reconstructive Surgery | 4301061751 | MI |
NPI | 1689624017 |
---|---|
Provider Name | Andrew J Livingston |
First Address | Grand Rapids, MI 49546 |
Second Address | Grand Rapids, MI 49546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 13/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4694901 | (05) | MI |
H37168 | (02) | MI |