Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301077917 | MI |
N | 111NI0900X | Internist | 4301077917 | MI |
N | 207RC0000X | Internist - Cardiovascular Disease | 4301077917 | MI |
Y | 207RI0011X | Interventional Cardiology | 4301077917 | MI |
NPI | 1063580595 |
---|---|
Provider Name | Andrzej S. Boguszewski |
First Address | Midland, MI 48640-2761 |
Second Address | Midland, MI 48640-2761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 04/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4301077917 | PHYSICIAN LICENSE (01) | MI |
BB8750184 | DEA (01) | |
I11696 | (02) |